Provider Demographics
NPI:1376230995
Name:CAMPBELL, GISELLE (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4726
Mailing Address - Country:US
Mailing Address - Phone:347-493-7246
Mailing Address - Fax:
Practice Address - Street 1:219 25TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1337
Practice Address - Country:US
Practice Address - Phone:929-324-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist