Provider Demographics
NPI:1609941889
Name:BOBBITT, SIGNE
Entity Type:Individual
Prefix:
First Name:SIGNE
Middle Name:
Last Name:BOBBITT
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 1:2455 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8675 VALLEY CREEK ROAD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2337
Practice Address - Country:US
Practice Address - Phone:651-241-3000
Practice Address - Fax:651-241-3500
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN820483700OtherMEDICAL ASSISTANCE
MN820483700OtherMEDICAL ASSISTANCE
MN826473000Medicare UPIN
MN6168355Medicare UPIN
MN766851045933Medicare UPIN
MNHP58817Medicare UPIN
MN80G87BOMedicare UPIN