Provider Demographics
NPI:1861858672
Name:CAMPBELL, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2133
Mailing Address - Country:US
Mailing Address - Phone:307-254-4934
Mailing Address - Fax:
Practice Address - Street 1:85 3RD ST
Practice Address - Street 2:
Practice Address - City:COWLEY
Practice Address - State:WY
Practice Address - Zip Code:82420-2133
Practice Address - Country:US
Practice Address - Phone:307-254-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services