Healthcare Provider Details

I. General information

NPI: 1073926325
Provider Name (Legal Business Name): CATHERINE J CAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 E 15TH ST
PANAMA CITY FL
32405-6345
US

IV. Provider business mailing address

914 HARRISON AVE
PANAMA CITY FL
32401-2528
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-5272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17460
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: