Provider Demographics
NPI:1013115849
Name:BOMBA, JANE M (SLP-CF)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:BOMBA
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 DENMEADE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8614
Mailing Address - Country:US
Mailing Address - Phone:704-650-8545
Mailing Address - Fax:
Practice Address - Street 1:6845 KNIGHTDALE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9800
Practice Address - Country:US
Practice Address - Phone:919-844-6611
Practice Address - Fax:919-844-6612
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005263235Z00000X
NC12238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist