Healthcare Provider Details

I. General information

NPI: 1093647539
Provider Name (Legal Business Name): ANGELA CAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 COOPER FOSTER PARK RD STE A
AMHERST OH
44001-1216
US

IV. Provider business mailing address

955 W SAINT CLAIR AVE APT 1616
CLEVELAND OH
44113-1240
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-3400
  • Fax:
Mailing address:
  • Phone: 440-668-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.16207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: