Provider Demographics
NPI:1922766252
Name:TUCKER, CAMILLE JOSEPHINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JOSEPHINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 TAFT PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3826
Mailing Address - Country:US
Mailing Address - Phone:504-377-8385
Mailing Address - Fax:
Practice Address - Street 1:820 TAFT PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3826
Practice Address - Country:US
Practice Address - Phone:504-377-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty