MEDICARE: JESSICA 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	1041C0700X	Clinical Social Worker	6801097077	MI

General Provider Information

NPI Number	:	1912309634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CAMPBELL

Provider Business Mailing Address
First Line	:	5756 FORDHAM CIR
Second Line	:	PLEASE SELECT
City	:	CANTON
State	:	MI
Zip	:	48187-3344
Country	:	US
Telephone Number	:	248-943-8009
Fax Number	:

Provider Business Practice Location Address
First Line	:	5756 FORDHAM CIR
Second Line	:	PLEASE SELECT
City	:	CANTON
State	:	MI
Zip	:	48187-3344
Country	:	US
Telephone Number	:	248-943-8009
Fax Number	:

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

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	07/15/2016

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Directions to “ JESSICA CAMPBELL ” Practice Location

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