Provider Demographics
NPI:1639267206
Name:CAMPBELL, ROBERT LAMONT (AUD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAMONT
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MILL ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-1542
Mailing Address - Country:US
Mailing Address - Phone:814-274-8655
Mailing Address - Fax:
Practice Address - Street 1:536 E 2ND ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9438
Practice Address - Country:US
Practice Address - Phone:814-274-9097
Practice Address - Fax:814-274-0464
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000280-L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000576009002OtherNY BCBS
PA01779308OtherPAMA
PACA7812655OtherBCBS
PA01779308OtherPAMA