Provider Demographics
NPI:1124044888
Name:CHAMPION, TEMPII (PHD,MS,CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:TEMPII
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:PHD,MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 DELAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5947
Mailing Address - Country:US
Mailing Address - Phone:203-531-7632
Mailing Address - Fax:203-531-7632
Practice Address - Street 1:320 DELAVAN AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5947
Practice Address - Country:US
Practice Address - Phone:203-531-7632
Practice Address - Fax:203-531-7632
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6863235Z00000X
NY005452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888921000Medicaid