Individual
MRS. AMANDA MARIE CHAMPION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
6501 N SHERIDAN RD, PEORIA, IL 61614
(309) 692-8670
(309) 692-8673
Mailing address
600 S 13TH STREET, PEKIN, IL 61554
(309) 353-0382
(309) 347-3529
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146008397
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215148
GROUP#BLUESHIELD OF IL
IL
Enumeration date
01/20/2006
Last updated
10/21/2010
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