Provider Demographics
NPI:1215386370
Name:BOBO, JACQUELINE MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:BOBO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4307
Mailing Address - Country:US
Mailing Address - Phone:855-838-3942
Mailing Address - Fax:
Practice Address - Street 1:1029 BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4307
Practice Address - Country:US
Practice Address - Phone:855-838-3942
Practice Address - Fax:803-572-5319
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6003235Z00000X
SCSLP.6003 SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist