Provider Demographics
NPI:1649019605
Name:CHAMPAGNE, VERONICA (SLPA)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:CHAMPAGNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5743 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-5249
Mailing Address - Country:US
Mailing Address - Phone:480-714-3171
Mailing Address - Fax:
Practice Address - Street 1:5743 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5249
Practice Address - Country:US
Practice Address - Phone:480-714-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA151942355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant