Provider Demographics
NPI:1669243416
Name:SCHAMBEAU, CORNELIA (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:SCHAMBEAU
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 1:11589 WINDSOR RD W
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-8207
Mailing Address - Country:US
Mailing Address - Phone:251-281-6744
Mailing Address - Fax:
Practice Address - Street 1:2440 GORDON SMITH DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2319
Practice Address - Country:US
Practice Address - Phone:251-300-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist