Provider Demographics
NPI:1992862304
Name:MONROE, BOBBIE J (AUD)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:J
Last Name:MONROE
Suffix:
Gender:F
Credentials:AUD
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 5649
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0649
Mailing Address - Country:US
Mailing Address - Phone:989-797-2400
Mailing Address - Fax:
Practice Address - Street 1:5161 CARDINAL PARK DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9435
Practice Address - Country:US
Practice Address - Phone:989-797-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000116231H00000X
MIBM000116237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI501OtherLICENSE
MI1601000116OtherAUDIOLOGY LICENCE
WI41153100Medicaid
MI1601000116OtherAUDIOLOGY LICENCE