Provider Demographics
NPI:1861270308
Name:BOBB, VERONICA LYNN
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNN
Last Name:BOBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 KALISTE SALOOM RD UNIT 701
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7635
Mailing Address - Country:US
Mailing Address - Phone:337-423-1169
Mailing Address - Fax:
Practice Address - Street 1:3601 KALISTE SALOOM RD UNIT 701
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7635
Practice Address - Country:US
Practice Address - Phone:337-423-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14687104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker