MEDICARE: CHRISTINE 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	235Z00000X	Speech-Language Pathologist	002863	CT

General Provider Information

NPI Number	:	1962742247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CAMPBELL

Provider Business Mailing Address
First Line	:	210 GEORGE ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 GEORGE ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2823
Country	:	US
Telephone Number	:	860-296-9166
Fax Number	:

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

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	02/22/2013

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Directions to “ CHRISTINE CAMPBELL ” Practice Location

Language	Start Address	Practice Location

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