MEDICARE: CASEY CAMPBELL

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	235Z00000X	Speech-Language Pathologist	22005233A	IN

General Provider Information

NPI Number	:	1699059527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY CAMPBELL

Provider Business Mailing Address
First Line	:	5617 SCARLET OAK RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5617 SCARLET OAK RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7743
Country	:	US
Telephone Number	:	812-697-0278
Fax Number	:

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

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

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Directions to “ CASEY CAMPBELL ” Practice Location

Language	Start Address	Practice Location

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