Provider Demographics
NPI:1811157605
Name:CHA, CAMIELLE CASALENA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAMIELLE
Middle Name:CASALENA
Last Name:CHA
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 1:4831 ROCK ROSE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9290
Mailing Address - Country:US
Mailing Address - Phone:407-493-9417
Mailing Address - Fax:
Practice Address - Street 1:4831 ROCK ROSE LOOP
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9290
Practice Address - Country:US
Practice Address - Phone:407-493-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist