Provider Demographics
NPI:1043683451
Name:BAILEY, ANDREW S (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:S
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W SUMMIT AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9431
Mailing Address - Country:US
Mailing Address - Phone:262-682-3147
Mailing Address - Fax:
Practice Address - Street 1:200 W SUMMIT AVE STE 260
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9431
Practice Address - Country:US
Practice Address - Phone:262-682-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8383-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical