Healthcare Provider Details

I. General information

NPI: 1962284331
Provider Name (Legal Business Name): LISA GAIL CAMPBELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA GAIL LAWSON LMT

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S NATIONAL AVE STE 407
SPRINGFIELD MO
65804-2213
US

IV. Provider business mailing address

1911 S NATIONAL AVE STE 407
SPRINGFIELD MO
65804-2213
US

V. Phone/Fax

Practice location:
  • Phone: 417-612-8508
  • Fax:
Mailing address:
  • Phone: 417-612-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2020034493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: