Provider Demographics
NPI:1023198017
Name:CAMPBELL, ANNETTE D (EDS)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3014
Mailing Address - Country:US
Mailing Address - Phone:520-696-8837
Mailing Address - Fax:
Practice Address - Street 1:1450 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3014
Practice Address - Country:US
Practice Address - Phone:520-696-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered174400000XOther Service ProvidersSpecialist