Healthcare Provider Details

I. General information

NPI: 1609852581
Provider Name (Legal Business Name): FLORENCE CAMERON MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 476 BOX 25
FPO AP
96322
JP

IV. Provider business mailing address

PSC 476 BOX 1113
FPO AP
96322
JP

V. Phone/Fax

Practice location:
  • Phone: 95-650-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3648
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: