Healthcare Provider Details

I. General information

NPI: 1255543369
Provider Name (Legal Business Name): AUDREY J CAMPBELL BSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 W HACIENDA AVE STE 7
LAS VEGAS NV
89118-1541
US

IV. Provider business mailing address

4495 W HACIENDA AVE STE 7
LAS VEGAS NV
89118-1541
US

V. Phone/Fax

Practice location:
  • Phone: 702-385-5331
  • Fax: 702-385-5678
Mailing address:
  • Phone: 702-247-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4465-S
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: