Provider Demographics
NPI:1700456332
Name:CAMPBELL, BRIDGET ELLEN (CCC,SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELLEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ELLEN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC,SLP
Mailing Address - Street 1:102 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2804
Mailing Address - Country:US
Mailing Address - Phone:270-590-2875
Mailing Address - Fax:888-494-1640
Practice Address - Street 1:102 W FRONT ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2804
Practice Address - Country:US
Practice Address - Phone:270-590-2875
Practice Address - Fax:888-494-1640
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty