Provider Demographics
NPI:1073857900
Name:HARTLEY, CAMILLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 EATON CT
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9210
Mailing Address - Country:US
Mailing Address - Phone:509-420-0611
Mailing Address - Fax:
Practice Address - Street 1:1215 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5472
Practice Address - Country:US
Practice Address - Phone:509-543-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60325833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist