Healthcare Provider Details

I. General information

NPI: 1053858159
Provider Name (Legal Business Name): SCOTT CAMPBELL LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 JEFFERSON AVE
TOLEDO OH
43604-5836
US

IV. Provider business mailing address

1219 JEFFERSON AVE
TOLEDO OH
43604-5836
US

V. Phone/Fax

Practice location:
  • Phone: 567-289-2273
  • Fax:
Mailing address:
  • Phone: 567-289-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1302664
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: