Provider Demographics
NPI:1285845198
Name:CAMPBELL, STEPHANIE NOELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NOELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 TIPPERARY TRL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-5300
Mailing Address - Country:US
Mailing Address - Phone:540-898-8498
Mailing Address - Fax:
Practice Address - Street 1:1201 SAM PERRY BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4490
Practice Address - Country:US
Practice Address - Phone:540-741-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist