Basic Information
Provider Information | |||||||||
NPI: | 1710102298 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RECORDS | ||||||||
FirstName: | BOBBYE | ||||||||
MiddleName: | RUTH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CCC/SLP, BCBA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2104 GREENBRIAR DR STE A | ||||||||
Address2: |   | ||||||||
City: | SOUTHLAKE | ||||||||
State: | TX | ||||||||
PostalCode: | 760928355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8174429022 | ||||||||
FaxNumber: | 8663008627 | ||||||||
Practice Location | |||||||||
Address1: | 2104 GREENBRIAR DR STE A | ||||||||
Address2: |   | ||||||||
City: | SOUTHLAKE | ||||||||
State: | TX | ||||||||
PostalCode: | 760928355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8174429022 | ||||||||
FaxNumber: | 8663008627 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2007 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-10-7860 | TX | N |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   | 235Z00000X | 13009 | TX | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.