Healthcare Provider Details

I. General information

NPI: 1992673578
Provider Name (Legal Business Name): KRYSTALEY CAMPBELL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E SEMINOLE ST
SPRINGFIELD MO
65807-2949
US

IV. Provider business mailing address

625 E SEMINOLE ST
SPRINGFIELD MO
65807-2949
US

V. Phone/Fax

Practice location:
  • Phone: 712-501-2100
  • Fax:
Mailing address:
  • Phone: 712-501-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number00-26-17111
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: