Provider Demographics
NPI:1073935201
Name:CAMPBELL, JEANNINE MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 UNION ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3050
Mailing Address - Country:US
Mailing Address - Phone:207-217-4956
Mailing Address - Fax:
Practice Address - Street 1:905 UNION ST
Practice Address - Street 2:SUITE 10
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3050
Practice Address - Country:US
Practice Address - Phone:207-973-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist