Provider Demographics
NPI:1255408779
Name:KAMPA, NANCY J (MA, LP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:KAMPA
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 PENN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2026
Mailing Address - Country:US
Mailing Address - Phone:952-888-0640
Mailing Address - Fax:
Practice Address - Street 1:7900 INTERNATIONAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1510
Practice Address - Country:US
Practice Address - Phone:612-725-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist