Provider Demographics
NPI:1851572697
Name:CAMERON, TAMRA LEE (CCC-SLP/SLPA/TSLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:LEE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:CCC-SLP/SLPA/TSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 E GUADALUPE RD
Mailing Address - Street 2:500 E. HOUSTON GILBERT AZ 85234
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1752
Mailing Address - Country:US
Mailing Address - Phone:602-321-0745
Mailing Address - Fax:480-641-8576
Practice Address - Street 1:500 E HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3427
Practice Address - Country:US
Practice Address - Phone:602-321-0745
Practice Address - Fax:480-641-8576
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5690235Z00000X
AZSLP5690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ786459OtherAHCCCS