Provider Demographics
NPI:1770725269
Name:CAMPBELL, TINA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 ROWLAND RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8514
Mailing Address - Country:US
Mailing Address - Phone:318-498-0812
Mailing Address - Fax:
Practice Address - Street 1:208 SWEETWATER RIM
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5691
Practice Address - Country:US
Practice Address - Phone:318-419-8170
Practice Address - Fax:188-735-9403
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist