Provider Demographics
NPI:1518116417
Name:WOBIG, TERRANCE RICHARD (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:RICHARD
Last Name:WOBIG
Suffix:
Gender:M
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:RICHARD
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:66 SHADY OAK CT
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6034
Mailing Address - Country:US
Mailing Address - Phone:507-454-0000
Mailing Address - Fax:507-454-6724
Practice Address - Street 1:66 SHADY OAK CT
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6034
Practice Address - Country:US
Practice Address - Phone:507-454-0000
Practice Address - Fax:507-454-6724
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist