Provider Demographics
NPI:1548567217
Name:CAMPBELL, STEPHANIE HAZEL (CLINICAL CERTIFICATI)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:HAZEL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CLINICAL CERTIFICATI
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:HAZEL
Other - Last Name:PRITCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DONAHUE AVENUE
Mailing Address - Street 2:LAWRENCE PUBLIC SCHOOL
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096
Mailing Address - Country:US
Mailing Address - Phone:516-295-6200
Mailing Address - Fax:516-295-6213
Practice Address - Street 1:DONAHUE AVENUE
Practice Address - Street 2:NUMBER TWO SCHOOL
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096
Practice Address - Country:US
Practice Address - Phone:516-295-6200
Practice Address - Fax:516-295-6213
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12068005Medicare UPIN