Provider Demographics
NPI:1205815495
Name:CAMPBELL NEUROPSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:CAMPBELL NEUROPSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-252-2522
Mailing Address - Street 1:6200 AURORA AVE STE 202W
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2876
Mailing Address - Country:US
Mailing Address - Phone:515-252-2522
Mailing Address - Fax:515-252-2523
Practice Address - Street 1:6200 AURORA AVE STE 202W
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2876
Practice Address - Country:US
Practice Address - Phone:515-252-2522
Practice Address - Fax:515-252-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00899103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA232250OtherMIDLANDS CHOICE NUMBER
IA37722OtherWELLMARK NUMBER
IAIA0101OtherJOHN DEERE NUMBER
IAIA0101OtherUNITED BEHAVIORAL HEALTH
IA37722OtherWELLMARK NUMBER