Provider Demographics
NPI:1225219629
Name:SHEDD, BOBBIE JO (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:SHEDD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 ALTISMA WAY
Mailing Address - Street 2:108
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6305
Mailing Address - Country:US
Mailing Address - Phone:619-681-4299
Mailing Address - Fax:
Practice Address - Street 1:2251 ALTISMA WAY
Practice Address - Street 2:108
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6305
Practice Address - Country:US
Practice Address - Phone:619-681-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist