Provider Demographics
NPI:1578760575
Name:BOLEY, REBA JO (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBA
Middle Name:JO
Last Name:BOLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2701 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-3719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 WEST NASHVILLE STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266
Practice Address - Country:US
Practice Address - Phone:270-475-4227
Practice Address - Fax:270-475-4173
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist