MEDICARE: KAITLIN P CAMPBELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	40996	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619253929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN P CAMPBELL LCSW

Provider Business Mailing Address
First Line	:	10125 RIDGEHAVEN DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-2749
Country	:	US
Telephone Number	:	512-560-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	12801 N CENTRAL EXPY STE 510
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1716
Country	:	US
Telephone Number	:	512-560-0464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	11/18/2025

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