Healthcare Provider Details

I. General information

NPI: 1467116004
Provider Name (Legal Business Name): JANINE M CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PUBLIC SQ
TROY OH
45373-3272
US

IV. Provider business mailing address

405 PUBLIC SQ
TROY OH
45373-3272
US

V. Phone/Fax

Practice location:
  • Phone: 937-356-3175
  • Fax:
Mailing address:
  • Phone: 937-356-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2304910
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC2103566TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: