Provider Demographics
NPI:1497046478
Name:WALLICK, BOBBIE J (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:J
Last Name:WALLICK
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 1:2680 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3349
Mailing Address - Country:US
Mailing Address - Phone:401-433-6217
Mailing Address - Fax:
Practice Address - Street 1:2680 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3349
Practice Address - Country:US
Practice Address - Phone:401-435-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist