Provider Demographics
NPI:1043406465
Name:CAMPBELL, SARA JEAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JEAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-2158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5214 SOUTH EAST STREET
Practice Address - Street 2:BUILDING D SUITE 1 HTS OUTPATIENT THERAPY SERVICES
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3750
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004841A235Z00000X
IN46001751A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist