Provider Demographics
NPI:1649558123
Name:CAMP, TRAVIS J (SLP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:CAMP
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:2541 PASS RD
Practice Address - Street 2:SUITE F
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2106
Practice Address - Country:US
Practice Address - Phone:228-388-1002
Practice Address - Fax:228-388-1006
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015077Medicaid
MS1033218524OtherGROUP NPI
MS09015077Medicaid