Provider Demographics
NPI:1982958781
Name:CAMPBELL, NICHOLAS BRIAN (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:BRIAN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6746 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3756
Mailing Address - Country:US
Mailing Address - Phone:314-645-4845
Mailing Address - Fax:
Practice Address - Street 1:6746 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3756
Practice Address - Country:US
Practice Address - Phone:314-645-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist