Healthcare Provider Details

I. General information

NPI: 1215661087
Provider Name (Legal Business Name): KYLIE CAMPBELL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VOORHEES TOWN CTR
VOORHEES NJ
08043-1910
US

IV. Provider business mailing address

2050 VOORHEES TOWN CTR
VOORHEES NJ
08043-1910
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax: 800-691-4185
Mailing address:
  • Phone: 856-346-0005
  • Fax: 800-691-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35SI00793800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: