Provider Demographics
NPI:1609231646
Name:JOBE, CORLEY (CCC, SLP)
Entity Type:Individual
Prefix:
First Name:CORLEY
Middle Name:
Last Name:JOBE
Suffix:
Gender:F
Credentials: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:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75902-0952
Mailing Address - Country:US
Mailing Address - Phone:936-639-3007
Mailing Address - Fax:936-639-3012
Practice Address - Street 1:360 NORTH JOHN REDDITT DR.
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2606
Practice Address - Country:US
Practice Address - Phone:936-639-3007
Practice Address - Fax:936-639-3012
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist