Provider Demographics
NPI:1558511808
Name:CAMPBELL, KENDRA LYNN (CMT)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SOUTH AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8000
Mailing Address - Country:US
Mailing Address - Phone:406-868-8458
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8000
Practice Address - Country:US
Practice Address - Phone:406-868-8458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBL20080790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist