Provider Demographics
NPI:1649509449
Name:CAMP, MEREDITH NICOLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:NICOLE
Last Name:CAMP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BRITTON CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8542
Mailing Address - Country:US
Mailing Address - Phone:870-378-0150
Mailing Address - Fax:
Practice Address - Street 1:1220 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4519
Practice Address - Country:US
Practice Address - Phone:870-931-4200
Practice Address - Fax:870-931-4201
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163086721Medicaid