MEDICARE: MR. RASHAWN JAMALL 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
1	373H00000X	Day Training/Habilitation Specialist
2	172A00000X	Driver

General Provider Information

NPI Number	:	1518725845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RASHAWN JAMALL CAMPBELL

Provider Business Mailing Address
First Line	:	2724 HERITAGE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3510
Country	:	US
Telephone Number	:	330-949-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 HERITAGE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3510
Country	:	US
Telephone Number	:	330-949-0242
Fax Number	:

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

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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