Provider Demographics
NPI:1033733399
Name:CAMPBELL, KATHRYN SUE (MS, CF/SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUE
Last Name:CAMPBELL
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 1:1600 RICE RD APT 1421
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3309
Mailing Address - Country:US
Mailing Address - Phone:903-393-3472
Mailing Address - Fax:
Practice Address - Street 1:1600 RICE RD APT 1421
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3309
Practice Address - Country:US
Practice Address - Phone:903-393-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist