Provider Demographics
NPI:1285065300
Name:CAMP-GERMANN, ELISABETH DIANE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:DIANE
Last Name:CAMP-GERMANN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:1788 COUNTY ROAD 120
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680
Mailing Address - Country:US
Mailing Address - Phone:606-922-3637
Mailing Address - Fax:888-866-8740
Practice Address - Street 1:2312 13TH ST STE A
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3524
Practice Address - Country:US
Practice Address - Phone:606-922-3637
Practice Address - Fax:888-866-8740
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13247235Z00000X
KY243356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist