Provider Demographics
NPI:1407429392
Name:BOBENHOUSE, ATRALL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ATRALL
Middle Name:
Last Name:BOBENHOUSE
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 1:6015 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2835
Mailing Address - Country:US
Mailing Address - Phone:618-926-5658
Mailing Address - Fax:
Practice Address - Street 1:14360 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5710
Practice Address - Country:US
Practice Address - Phone:314-434-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist