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NPI Code Detail

MEDICARE: PATRICIA ELAINE CAMPBELL

MEDICARE:   PATRICIA ELAINE CAMPBELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1194887851
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA ELAINE CAMPBELL
Provider Business Mailing Address
First Line : 614 SHANNON CT NE
Second Line :
City : KEIZER
State : OR
Zip : 97303-4384
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3180 CENTER ST NE
Second Line :
City : SALEM
State : OR
Zip : 97301-4532
Country : US
Telephone Number : 503-584-4864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/08/2007

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Directions to “ PATRICIA ELAINE CAMPBELL ” Practice Location

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