Basic Information
| Provider Information | |||||||||
| NPI: | 1760812754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOBBITT | ||||||||
| FirstName: | STEVIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 MARCO DR | ||||||||
| Address2: | |||||||||
| City: | RANTOUL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618663464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173900439 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2423 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604355483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157259995 | ||||||||
| FaxNumber: | 8157259993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2013 | ||||||||
| LastUpdateDate: | 11/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146010665 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.