Provider Demographics
NPI:1174815179
Name:GEORGE, CALLIE J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:J
Last Name:GEORGE
Suffix:
Gender:F
Credentials: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 1:8500 STATE ROUTE 503 S
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-8999
Mailing Address - Country:US
Mailing Address - Phone:937-533-6739
Mailing Address - Fax:
Practice Address - Street 1:8500 STATE ROUTE 503 S
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311-8999
Practice Address - Country:US
Practice Address - Phone:937-533-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist