Healthcare Provider Details

I. General information

NPI: 1649495169
Provider Name (Legal Business Name): BOBBYE RECORDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 GREENWOOD DR SUITE 100
SOUTHLAKE TX
76092-8360
US

IV. Provider business mailing address

2050 GREENWOOD DR STE 100
SOUTHLAKE TX
76092-8354
US

V. Phone/Fax

Practice location:
  • Phone: 817-865-1161
  • Fax: 866-300-8627
Mailing address:
  • Phone: 817-865-1161
  • Fax: 866-300-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13009
License Number StateTX

VIII. Authorized Official

Name: BOBBYE RUTH RECORDS
Title or Position: OWNER
Credential: CCC/SLP
Phone: 817-865-1161