MEDICARE: LARRY ELBERT BOBBITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	30003887	NC

General Provider Information

NPI Number	:	1104774082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY ELBERT BOBBITT

Provider Business Mailing Address
First Line	:	3517 COACH LANTERN AVE
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4866
Country	:	US
Telephone Number	:	919-948-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 COACH LANTERN AVE
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4866
Country	:	US
Telephone Number	:	919-948-8951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ LARRY ELBERT BOBBITT ” Practice Location

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