Provider Demographics
NPI:1033541370
Name:CAMPBELL, JACQUELINE J (MS, RD, CDN, LDN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, RD, CDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1907
Mailing Address - Country:US
Mailing Address - Phone:413-854-1277
Mailing Address - Fax:
Practice Address - Street 1:308 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4613
Practice Address - Country:US
Practice Address - Phone:860-698-0656
Practice Address - Fax:860-929-0858
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered