Healthcare Provider Details

I. General information

NPI: 1972622843
Provider Name (Legal Business Name): SUSAN KATHRYN CAMPBELL R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10204 GRANGER RD
GARFIELD HTS OH
44125-3106
US

IV. Provider business mailing address

4801 W 228TH ST
FAIRVIEW PARK OH
44126-2426
US

V. Phone/Fax

Practice location:
  • Phone: 216-581-2900
  • Fax: 216-581-1517
Mailing address:
  • Phone: 440-777-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: