Provider Demographics
NPI:1316401540
Name:CAMPBELL, BRENNA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-3152
Mailing Address - Country:US
Mailing Address - Phone:816-418-5200
Mailing Address - Fax:
Practice Address - Street 1:21 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2012
Practice Address - Country:US
Practice Address - Phone:401-722-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000889235Z00000X
RISP00462-P235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist