Provider Demographics
NPI:1861014094
Name:GORMAN, CAMMEY K (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAMMEY
Middle Name:K
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256-0184
Mailing Address - Country:US
Mailing Address - Phone:518-420-4064
Mailing Address - Fax:
Practice Address - Street 1:1110 NH ROUTE 175
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03223-4638
Practice Address - Country:US
Practice Address - Phone:603-726-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist