Healthcare Provider Details

I. General information

NPI: 1003614967
Provider Name (Legal Business Name): CAMERON HOVERSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMERON COUSINS

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S ENNIS ST
BRYAN TX
77803-4642
US

IV. Provider business mailing address

3603 WINCHESTER CT
CORINTH TX
76210-4160
US

V. Phone/Fax

Practice location:
  • Phone: 979-209-1000
  • Fax:
Mailing address:
  • Phone: 469-644-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106460
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: