Provider Demographics
NPI:1952887689
Name:CAMPBELL, BRITTANY (CD,CLC, TM)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CD,CLC, TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N DADE AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1824
Mailing Address - Country:US
Mailing Address - Phone:314-536-1604
Mailing Address - Fax:
Practice Address - Street 1:8 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2409
Practice Address - Country:US
Practice Address - Phone:314-643-7703
Practice Address - Fax:314-736-5550
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO174N00000X, 374J00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
1120OtherDOB