Provider Demographics
NPI:1821366857
Name:CAMPBELL, TWYLAH J (CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MISS
First Name:TWYLAH
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23505 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2300
Mailing Address - Country:US
Mailing Address - Phone:347-495-9343
Mailing Address - Fax:
Practice Address - Street 1:555 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1928
Practice Address - Country:US
Practice Address - Phone:914-949-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021240-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist