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General NPI Number Information
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NPI Number | 1407679673
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Entity Type | Individual
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Provider Name | NICOLE CAMERON MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-966-2694
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Fax |
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Provider Business Mailing Address
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Address Line | 32130 PERSIMMON LN
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City | CHESTERFIELD
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State | MI
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Zip | 48047-4539
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Country | US
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Telephone | 586-770-5115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8219
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101009160
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License Number State | MI
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