=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982032066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY CAMPLIN M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2013
-----------------------------------------------------
Last Update Date | 10/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 DOWD CIR
-----------------------------------------------------
City | PINEHURST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28374-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-295-2609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5291 7 LKS W
-----------------------------------------------------
City | WEST END
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27376-9310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-690-7957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 5322
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------