Provider Demographics
NPI:1215532502
Name:CAMERON, TARIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARIA
Middle Name:
Last Name:CAMERON
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 1:2619 CLOVER FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-3233
Mailing Address - Country:US
Mailing Address - Phone:952-412-5703
Mailing Address - Fax:
Practice Address - Street 1:7924 VICTORIA DR # B
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-2800
Practice Address - Country:US
Practice Address - Phone:952-479-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528497235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist