Provider Demographics
NPI:1871286799
Name:SPAIN, CAMILLE SUZANNE (MS, CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:CAMILLE
Middle Name:SUZANNE
Last Name:SPAIN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLD WOODS AVE SE APT 501
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-1434
Mailing Address - Country:US
Mailing Address - Phone:703-894-7895
Mailing Address - Fax:
Practice Address - Street 1:1315 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4944
Practice Address - Country:US
Practice Address - Phone:540-982-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist