Provider Demographics
NPI:1295403434
Name:CAMPBELL, LAURIE ANN (PEER SPECIALIST)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 FRANKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-4002
Mailing Address - Country:US
Mailing Address - Phone:216-355-6582
Mailing Address - Fax:
Practice Address - Street 1:6325 FRANKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-4002
Practice Address - Country:US
Practice Address - Phone:216-355-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH17500000XMedicaid