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General NPI Number Information
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NPI Number | 1104774082
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Entity Type | Individual
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Provider Name | LARRY ELBERT BOBBITT
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Gender | Male
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 3517 COACH LANTERN AVE
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City | WAKE FOREST
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State | NC
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Zip | 27587-4866
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Country | US
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Telephone | 919-948-8951
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Fax |
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Provider Business Mailing Address
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Address Line | 3517 COACH LANTERN AVE
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City | WAKE FOREST
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State | NC
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Zip | 27587-4866
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Country | US
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Telephone | 919-948-8905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 30003887
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License Number State | NC
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