Provider Demographics
NPI:1942470075
Name:CAMPBELL, LEAH R
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:R
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 1:2072 122ND LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1805
Mailing Address - Country:US
Mailing Address - Phone:763-208-7335
Mailing Address - Fax:763-208-7335
Practice Address - Street 1:2072 122ND LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1805
Practice Address - Country:US
Practice Address - Phone:763-208-7335
Practice Address - Fax:763-208-7335
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver