Provider Demographics
NPI:1245668268
Name:VANKAMPEN, CORRIE
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:VANKAMPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GEDNEY ST
Mailing Address - Street 2:AUGUSTA SCHOOL DEPARTMENT
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4440
Mailing Address - Country:US
Mailing Address - Phone:207-626-2464
Mailing Address - Fax:207-626-2444
Practice Address - Street 1:12 GEDNEY ST
Practice Address - Street 2:AUGUSTA SCHOOL DEPARTMENT
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4440
Practice Address - Country:US
Practice Address - Phone:207-626-2464
Practice Address - Fax:207-626-2444
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist