Provider Demographics
NPI:1316516669
Name:BOBO, JOYCE RENAE (MS)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:RENAE
Last Name:BOBO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71960-8363
Mailing Address - Country:US
Mailing Address - Phone:870-490-1777
Mailing Address - Fax:
Practice Address - Street 1:235 N 11TH ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4903
Practice Address - Country:US
Practice Address - Phone:870-246-1100
Practice Address - Fax:870-246-1144
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201413390200000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program