Provider Demographics
NPI:1992823173
Name:CAMPBELL, SARAH ANN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
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 1:904 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2843
Mailing Address - Country:US
Mailing Address - Phone:440-315-4538
Mailing Address - Fax:
Practice Address - Street 1:3 MERIT DR
Practice Address - Street 2:GRANDE POINTE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-1457
Practice Address - Country:US
Practice Address - Phone:216-261-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist