Provider Demographics
NPI:1801456579
Name:BERNARD, CAMILLE NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:NICOLE
Last Name:BERNARD
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 1:23662 N WEE MA TUK RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:IL
Mailing Address - Zip Code:61427-9804
Mailing Address - Country:US
Mailing Address - Phone:309-224-5822
Mailing Address - Fax:
Practice Address - Street 1:2081 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-1032
Practice Address - Country:US
Practice Address - Phone:309-647-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005375235Z00000X
IL146.015317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist