Provider Demographics
NPI:1891554127
Name:BOBO, CARLY JANE
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:JANE
Last Name:BOBO
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 1:11840 ROAD 505
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-7324
Mailing Address - Country:US
Mailing Address - Phone:601-562-0089
Mailing Address - Fax:
Practice Address - Street 1:101 KIRKLAND ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-3205
Practice Address - Country:US
Practice Address - Phone:601-774-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist