Provider Demographics
NPI:1619410271
Name:CAMPBELL, JEANNIE MARIE (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LIVE OAK ST
Mailing Address - Street 2:6409
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8101 BOAT CLUB RD
Practice Address - Street 2:SUITE 160
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3630
Practice Address - Country:US
Practice Address - Phone:214-302-9725
Practice Address - Fax:214-935-2457
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352712355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant