Provider Demographics
NPI:1114084647
Name:CAMPBELL, GAYLE (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
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 1:667 HOPEWELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1579
Mailing Address - Country:US
Mailing Address - Phone:740-344-6557
Mailing Address - Fax:740-522-4634
Practice Address - Street 1:667 HOPEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1579
Practice Address - Country:US
Practice Address - Phone:740-344-6557
Practice Address - Fax:740-522-4634
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2155984Medicaid
OH2155984Medicaid