Provider Demographics
NPI:1447971809
Name:O'NEAL, BAILEY SAVANNAH
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:SAVANNAH
Last Name:O'NEAL
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 1:2170 N LAKE DR APT 2021
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8122
Mailing Address - Country:US
Mailing Address - Phone:843-229-6856
Mailing Address - Fax:
Practice Address - Street 1:1531 THREE DOG RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7621
Practice Address - Country:US
Practice Address - Phone:803-476-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist