Provider Demographics
NPI:1588455414
Name:MINNICK, BOBBI LYNN (MACCCSLP)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:LYNN
Last Name:MINNICK
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 HANNA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-3009
Mailing Address - Country:US
Mailing Address - Phone:814-873-2258
Mailing Address - Fax:
Practice Address - Street 1:4108 MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1968
Practice Address - Country:US
Practice Address - Phone:814-873-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist