MEDICARE: DR. HEATHER L CAMPBELL PHD

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
1	103TC0700X	Clinical Psychologist	2913	CO

General Provider Information

NPI Number	:	1437193141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER L CAMPBELL PHD

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-526-7155
Fax Number	:	719-503-7884

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-526-5177
Fax Number	:	719-503-7884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/07/2014

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