Provider Demographics
NPI:1336725530
Name:WEBB, BOBBIE JEAN (BA)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:WEBB
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N VORCEY ST
Mailing Address - Street 2:
Mailing Address - City:TOLONO
Mailing Address - State:IL
Mailing Address - Zip Code:61880-9683
Mailing Address - Country:US
Mailing Address - Phone:217-418-6930
Mailing Address - Fax:
Practice Address - Street 1:1304 W BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2035
Practice Address - Country:US
Practice Address - Phone:217-355-9176
Practice Address - Fax:217-398-7137
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency