Provider Demographics
NPI:1013615905
Name:CAMPBELL, RAHMANDA SALAMATU
Entity Type:Individual
Prefix:DR
First Name:RAHMANDA
Middle Name:SALAMATU
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 1:225 E CITY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1724
Mailing Address - Country:US
Mailing Address - Phone:215-395-8591
Mailing Address - Fax:302-834-0933
Practice Address - Street 1:225 E CITY AVE STE 108
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1724
Practice Address - Country:US
Practice Address - Phone:215-395-8591
Practice Address - Fax:302-834-0933
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE106S00000X, 261QH0700X
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech