Provider Demographics
NPI:1245400829
Name:LANCASTER, CAMILLE WILLIAMS (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:WILLIAMS
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-3301
Mailing Address - Country:US
Mailing Address - Phone:573-472-2435
Mailing Address - Fax:
Practice Address - Street 1:703 HICKORY DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-3301
Practice Address - Country:US
Practice Address - Phone:573-472-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist