Provider Demographics
NPI:1225219629
Name:SHEDD, BOBBIE JO (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:SHEDD
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 EL PRADO AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3219
Mailing Address - Country:US
Mailing Address - Phone:619-681-4299
Mailing Address - Fax:
Practice Address - Street 1:2332 EL PRADO AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3219
Practice Address - Country:US
Practice Address - Phone:619-681-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist