Individual
NICOLE M CHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
3816 HARRIS BLVD NW, KENNESAW, GA 30144-6095
(770) 608-3783
Mailing address
3816 HARRIS BLVD NW, KENNESAW, GA 30144-6095
(770) 608-3783
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007192
GA
Other
Enumeration date
04/16/2009
Last updated
05/22/2013
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