Provider Demographics
NPI:1578151890
Name:CAMPBELL, ELIZABETH MOSS (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MOSS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:HUNTER CHILD
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 CORINNE ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1620
Mailing Address - Country:US
Mailing Address - Phone:231-838-6129
Mailing Address - Fax:
Practice Address - Street 1:121 CORINNE ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1620
Practice Address - Country:US
Practice Address - Phone:231-838-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical