Provider Demographics
NPI:1821241688
Name:CAMPBELL-DUBLIN, MILLIE (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:
Last Name:CAMPBELL-DUBLIN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ADDICKS RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3524
Mailing Address - Country:US
Mailing Address - Phone:201-664-6704
Mailing Address - Fax:
Practice Address - Street 1:64 ADDICKS RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3524
Practice Address - Country:US
Practice Address - Phone:201-664-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003887-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist