Provider Demographics
NPI:1376127571
Name:CAMPBELL, MICHAYLA ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:MICHAYLA
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CURRAN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4502
Mailing Address - Country:US
Mailing Address - Phone:405-837-8180
Mailing Address - Fax:
Practice Address - Street 1:301 S BOULEVARD STE 126
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3880
Practice Address - Country:US
Practice Address - Phone:405-285-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist