Provider Demographics
NPI:1215812581
Name:LANDGRAF, BAILEY ISABEL
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:ISABEL
Last Name:LANDGRAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 ORION UNIT B
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-3294
Mailing Address - Country:US
Mailing Address - Phone:616-510-5677
Mailing Address - Fax:
Practice Address - Street 1:250 CHERRY LN
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4395
Practice Address - Country:US
Practice Address - Phone:209-210-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician