Healthcare Provider Details

I. General information

NPI: 1922914001
Provider Name (Legal Business Name): HANNAH MACKENZIE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 HOLCOMB RD
CLARKSTON MI
48348-4322
US

IV. Provider business mailing address

5874 SHORE CT
CLARKSTON MI
48346-2755
US

V. Phone/Fax

Practice location:
  • Phone: 248-623-3859
  • Fax:
Mailing address:
  • Phone: 586-808-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851118537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: