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Individual

BOBBETTE LOU TRACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A., CCC-SLP

Contact information

Practice address
2529 LENA CT, MINDEN, NV 89423-7021
(814) 795-1635
Mailing address
2529 LENA CT, MINDEN, NV 89423-7021
(814) 795-1635

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL007402
PA
235Z00000X
Speech-Language Pathologist
SP-1366
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
001444546
HIGHMARK BLUE CROSS
PA
05
1010232180002
PA
Enumeration date
04/09/2007
Last updated
04/18/2013
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