Provider Demographics
NPI:1760629166
Name:CAMPBELL, CHRISTINA E (SSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 N 490 W
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2264
Mailing Address - Country:US
Mailing Address - Phone:801-763-7775
Mailing Address - Fax:801-763-7651
Practice Address - Street 1:71 N 490 W
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2264
Practice Address - Country:US
Practice Address - Phone:801-763-7775
Practice Address - Fax:801-763-7651
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5604982-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker