Healthcare Provider Details

I. General information

NPI: 1831052778
Provider Name (Legal Business Name): SIGOURNEY TEGAN CAMPIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 LUISA ST STE 7
SANTA FE NM
87505-4177
US

IV. Provider business mailing address

PO BOX 423
EL PRADO NM
87529-0423
US

V. Phone/Fax

Practice location:
  • Phone: 847-915-2891
  • Fax:
Mailing address:
  • Phone: 847-915-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: