Provider Demographics
NPI:1215196498
Name:JOBE, KELLY DIANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DIANNE
Last Name:JOBE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 BRADFORD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-3438
Mailing Address - Country:US
Mailing Address - Phone:214-850-0577
Mailing Address - Fax:
Practice Address - Street 1:3000 HORIZON RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5817
Practice Address - Country:US
Practice Address - Phone:972-772-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51339231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist