Provider Demographics
NPI:1518008747
Name:CHAMP, DANIECE L (BC-HIS)
Entity Type:Individual
Prefix:
First Name:DANIECE
Middle Name:L
Last Name:CHAMP
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:DANIECE
Other - Middle Name:L
Other - Last Name:LAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:113 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2107
Mailing Address - Country:US
Mailing Address - Phone:812-522-4625
Mailing Address - Fax:812-523-8185
Practice Address - Street 1:113 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2107
Practice Address - Country:US
Practice Address - Phone:812-522-4625
Practice Address - Fax:812-523-8185
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001132A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist