=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962878751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAUREEN CAMPION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2015
-----------------------------------------------------
Last Update Date | 08/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6607 18TH AVE S STE 201
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-483-3487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6607 18TH AVE S STE 201
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-483-3487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | MAUREEN CAMPION
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-483-3487
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | LP 4079
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------