Provider Demographics
NPI:1487840708
Name:ANDERSEN, BAILEY KAMIN (MS)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:KAMIN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 BEAUMARIS DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7785
Mailing Address - Country:US
Mailing Address - Phone:727-518-4078
Mailing Address - Fax:
Practice Address - Street 1:10501 ROCHESTER WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1711
Practice Address - Country:US
Practice Address - Phone:813-833-0090
Practice Address - Fax:813-852-6373
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4338235Z00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist