Provider Demographics
NPI:1578173498
Name:SMITH, BOBBI GWEN
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:GWEN
Last Name:SMITH
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 1:29220 JAMES CHAPEL RD N
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-4203
Mailing Address - Country:US
Mailing Address - Phone:225-803-0151
Mailing Address - Fax:
Practice Address - Street 1:29220 JAMES CHAPEL RD N
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-4203
Practice Address - Country:US
Practice Address - Phone:225-803-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist