Provider Demographics
NPI:1891313078
Name:MERENDINO, CAMILLE ALEXIS (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ALEXIS
Last Name:MERENDINO
Suffix:
Gender:F
Credentials:MCD, 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 168
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-0168
Mailing Address - Country:US
Mailing Address - Phone:850-588-9641
Mailing Address - Fax:888-711-0441
Practice Address - Street 1:9511 CRESTVIEW DRIVE
Practice Address - Street 2:STE B
Practice Address - City:BATON ROUGH
Practice Address - State:LA
Practice Address - Zip Code:70836
Practice Address - Country:US
Practice Address - Phone:225-224-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist