Provider Demographics
NPI:1124199385
Name:CAMPBELL, BARBARA KANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:KANE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 NW KEARNEY ST
Mailing Address - Street 2:STE 24
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1465
Mailing Address - Country:US
Mailing Address - Phone:503-221-7074
Mailing Address - Fax:503-636-8784
Practice Address - Street 1:1942 NW KEARNEY ST
Practice Address - Street 2:SUITE 24
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1426
Practice Address - Country:US
Practice Address - Phone:503-227-3932
Practice Address - Fax:503-636-8784
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR560OtherPSYCHOLOGIST LICENSE
OR560OtherPSYCHOLOGIST LICENSE