Provider Demographics
NPI:1386318459
Name:CANO, CAMI LORENE
Entity type:Individual
Prefix:
First Name:CAMI
Middle Name:LORENE
Last Name:CANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E WINDING CREEK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7242
Mailing Address - Country:US
Mailing Address - Phone:208-938-4748
Mailing Address - Fax:208-938-1710
Practice Address - Street 1:1106 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2130
Practice Address - Country:US
Practice Address - Phone:541-216-5115
Practice Address - Fax:541-216-5116
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist