Provider Demographics
NPI:1467139097
Name:BOBO, REBEKAH LEIGH
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEIGH
Last Name:BOBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 RANCHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4711
Mailing Address - Country:US
Mailing Address - Phone:404-313-4628
Mailing Address - Fax:
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW STE 603
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4218
Practice Address - Country:US
Practice Address - Phone:770-974-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist