Provider Demographics
NPI:1639455116
Name:CAMPBELL, TAMMY CARWILE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:CARWILE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:KAYE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:120 QUEENS CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1910
Mailing Address - Country:US
Mailing Address - Phone:850-747-1198
Mailing Address - Fax:
Practice Address - Street 1:807 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-9495
Practice Address - Country:US
Practice Address - Phone:850-866-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist