Healthcare Provider Details

I. General information

NPI: 1952887689
Provider Name (Legal Business Name): BRITTANY CAMPBELL CD,CLC, TM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CHURCH ST
FERGUSON MO
63135-2409
US

IV. Provider business mailing address

100 N DADE AVE
FERGUSON MO
63135-1824
US

V. Phone/Fax

Practice location:
  • Phone: 314-643-7703
  • Fax: 314-736-5550
Mailing address:
  • Phone: 314-536-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: