Healthcare Provider Details

I. General information

NPI: 1528472164
Provider Name (Legal Business Name): KATHLEEN CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SHADY LAKE CT
ST AUGUSTINE FL
32095-8977
US

IV. Provider business mailing address

6 STRATHMORE RD
NATICK MA
01760-2419
US

V. Phone/Fax

Practice location:
  • Phone: 407-433-7870
  • Fax: 800-958-0590
Mailing address:
  • Phone: 508-650-5990
  • Fax: 508-650-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: