Provider Demographics
NPI:1073370078
Name:JENNIFER CAMPBELL LCSW, LCAC
Entity Type:Organization
Organization Name:JENNIFER CAMPBELL LCSW, LCAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC
Authorized Official - Phone:131-744-7818
Mailing Address - Street 1:877 SABLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9767
Mailing Address - Country:US
Mailing Address - Phone:317-447-8186
Mailing Address - Fax:
Practice Address - Street 1:505 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1256
Practice Address - Country:US
Practice Address - Phone:317-447-8186
Practice Address - Fax:317-534-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health