Provider Demographics
NPI:1285148163
Name:CHAMPAGNE, JOANNE (SPEECH/LANGUAGE PATH)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:SPEECH/LANGUAGE PATH
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:BUTHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5149
Mailing Address - Country:US
Mailing Address - Phone:630-876-8541
Mailing Address - Fax:
Practice Address - Street 1:526 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5149
Practice Address - Country:US
Practice Address - Phone:630-876-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist