Provider Demographics
NPI:1063566115
Name:CAMPBELL, JENNIFER LEIGH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#9 N. SYCAMORE COURT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-0618
Mailing Address - Country:US
Mailing Address - Phone:575-624-2095
Mailing Address - Fax:575-627-5721
Practice Address - Street 1:804 N. UNION
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-624-2095
Practice Address - Fax:575-627-5721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist