Provider Demographics
NPI:1770147654
Name:HAM, CHAMPAGNE MONIQUE
Entity type:Individual
Prefix:
First Name:CHAMPAGNE
Middle Name:MONIQUE
Last Name:HAM
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 1:3383 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2102
Mailing Address - Country:US
Mailing Address - Phone:989-992-8499
Mailing Address - Fax:
Practice Address - Street 1:90 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1629
Practice Address - Country:US
Practice Address - Phone:234-334-5592
Practice Address - Fax:800-480-7579
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician