Basic Information
| Provider Information | |||||||||
| NPI: | 1275760274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRIPE | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | NICHOLE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CRIPE | ||||||||
| OtherFirstName: | CAMI | ||||||||
| OtherMiddleName: | NICHOLE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A., CCC-SLP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1714 COLLEGE MANOR DR | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465265150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5749718669 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 N. WABASH AVE. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513229 | ||||||||
| FaxNumber: | 7656513227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22004525A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.