Provider Demographics
NPI:1942363619
Name:CAMPBELL, SARA SLOAN (LMP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:SLOAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7026
Mailing Address - Country:US
Mailing Address - Phone:253-756-1169
Mailing Address - Fax:253-761-4344
Practice Address - Street 1:8404 27TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-2723
Practice Address - Country:US
Practice Address - Phone:253-226-5228
Practice Address - Fax:253-761-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist