Provider Demographics
NPI:1538766761
Name:STEIDEN, CAMILLE (MA, CCC-SLP, CLC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:STEIDEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 ROXBORO RD NE APT NO5118
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1795
Mailing Address - Country:US
Mailing Address - Phone:502-550-6772
Mailing Address - Fax:
Practice Address - Street 1:300 W WIEUCA RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:404-808-5427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist