Provider Demographics
NPI:1821352014
Name:BOLDEN-CAMPBELL, SHARDE SHERMANE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARDE
Middle Name:SHERMANE
Last Name:BOLDEN-CAMPBELL
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 1:907 CHRISTOPHER
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3493
Mailing Address - Country:US
Mailing Address - Phone:225-937-3630
Mailing Address - Fax:
Practice Address - Street 1:907 CHRISTOPHER
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3493
Practice Address - Country:US
Practice Address - Phone:225-937-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6339235Z00000X
TX109675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist