Provider Demographics
NPI:1881030690
Name:CAMPO, ANASTASIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:CAMPO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 ORSOTA CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5002
Mailing Address - Country:US
Mailing Address - Phone:407-715-1137
Mailing Address - Fax:
Practice Address - Street 1:2422 ORSOTA CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5002
Practice Address - Country:US
Practice Address - Phone:407-715-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009066800Medicaid