=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336452705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT L CAMPBELL MSW, CSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2010
-----------------------------------------------------
Last Update Date | 07/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2480 S MAIN ST
-----------------------------------------------------
City | SOUTH SALT LAKE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84115-3058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-485-3722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 E 670 N
-----------------------------------------------------
City | TOOELE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84074-9269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7060725-3502
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------