Provider Demographics
NPI:1235786096
Name:CAMPBELL, KRISTIN R
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11268 TOWNSHIP ROAD 101
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9608
Mailing Address - Country:US
Mailing Address - Phone:330-883-8396
Mailing Address - Fax:
Practice Address - Street 1:1100 BROAD AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-2651
Practice Address - Country:US
Practice Address - Phone:419-425-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.07805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.07802OtherOHIO BOARD OF SPEECH PATHOLOGY AND AUDIOLOGTY