Provider Demographics
NPI:1154461952
Name:CAMPBELL, FRANK DALE (EDS)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:DALE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W LINCOLN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537
Mailing Address - Country:US
Mailing Address - Phone:218-739-0683
Mailing Address - Fax:218-739-0683
Practice Address - Street 1:125 W LINCOLN
Practice Address - Street 2:SUITE 12
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:218-739-0683
Practice Address - Fax:218-739-0683
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0124103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist