Provider Demographics
NPI:1649746751
Name:EDWARDS, CAMILLE ANN
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAMILLE
Other - Middle Name:ANN
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5242
Mailing Address - Country:US
Mailing Address - Phone:765-289-3341
Mailing Address - Fax:
Practice Address - Street 1:2200 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5242
Practice Address - Country:US
Practice Address - Phone:765-289-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004672A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22004672AOtherSTATE LICENSE