Provider Demographics
NPI:1508205170
Name:CAMPBELL, RALPH BLANE III (LADC)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:BLANE
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1629
Mailing Address - Country:US
Mailing Address - Phone:952-922-1476
Mailing Address - Fax:952-922-1476
Practice Address - Street 1:6700 POINT DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1629
Practice Address - Country:US
Practice Address - Phone:952-922-1476
Practice Address - Fax:952-922-1476
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCD 302697101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)