Provider Demographics
NPI:1972622843
Name:CAMPBELL, SUSAN KATHRYN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KATHRYN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 W 228TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2426
Mailing Address - Country:US
Mailing Address - Phone:440-777-3649
Mailing Address - Fax:
Practice Address - Street 1:10204 GRANGER RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3106
Practice Address - Country:US
Practice Address - Phone:216-581-2900
Practice Address - Fax:216-581-1517
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered