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NPI Code Detail

MEDICARE: JENNA LYNN CAMPO

MEDICARE: JENNA LYNN CAMPO
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
1106S00000XBehavior TechnicianRBT-17-46845CO
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1548777501
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA LYNN CAMPO
Provider Business Mailing Address
First Line : 209 S HORNING RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44903-8627
Country : US
Telephone Number : 419-989-7930
Fax Number :
Provider Business Practice Location Address
First Line : 1033 LARCHWOOD RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-2424
Country : US
Telephone Number : 419-747-4122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2017
Last Update Date : 12/29/2017

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Directions to “ JENNA LYNN CAMPO ” Practice Location

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