Provider Demographics
NPI:1275774945
Name:CAMPBELL, CHRISTINE A (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 CONCORD RD
Mailing Address - Street 2:C/O LAFAYETTE ENT
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-2710
Mailing Address - Country:US
Mailing Address - Phone:765-477-7436
Mailing Address - Fax:765-477-1245
Practice Address - Street 1:2320 CONCORD RD
Practice Address - Street 2:C/O LAFAYETTE ENT
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2710
Practice Address - Country:US
Practice Address - Phone:765-477-7436
Practice Address - Fax:765-477-1245
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002071A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist