Provider Demographics
NPI:1215194535
Name:CAMPBELL, JILL LORRYN (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:LORRYN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 LANGMAID LN
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:585-968-3877
Mailing Address - Fax:585-968-1522
Practice Address - Street 1:412 LANGMAID LN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:585-968-3877
Practice Address - Fax:585-968-1522
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008037-1235Z00000X
PASL004368L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist