Provider Demographics
NPI:1932672581
Name:FUMO, CAMILLE ANN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:ANN
Last Name:FUMO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-2411
Mailing Address - Country:US
Mailing Address - Phone:856-777-0033
Mailing Address - Fax:
Practice Address - Street 1:751 NJ-73 NORTH
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-375-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2024-12-19
Deactivation Date:2019-01-14
Deactivation Code:
Reactivation Date:2024-12-19
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00962400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty