Provider Demographics
NPI:1952551962
Name:CAMPBELL, MEGAN ELIZABETH (BS, MS)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:WIKSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MS
Mailing Address - Street 1:33 MARSEILLE WAY
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1911
Mailing Address - Country:US
Mailing Address - Phone:206-445-5744
Mailing Address - Fax:949-398-9822
Practice Address - Street 1:17291 IRVINE BLVD STE 375
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2915
Practice Address - Country:US
Practice Address - Phone:949-236-7126
Practice Address - Fax:949-398-9822
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13137235Z00000X
CA31660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist