Provider Demographics
NPI:1194940114
Name:CAMPBELL, JACQUELINE ROMNEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ROMNEY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2857 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2812
Mailing Address - Country:US
Mailing Address - Phone:801-582-5385
Mailing Address - Fax:801-583-2154
Practice Address - Street 1:262 E 3900 S
Practice Address - Street 2:SUITE 103
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1550
Practice Address - Country:US
Practice Address - Phone:801-651-9261
Practice Address - Fax:801-583-2154
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT269235-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical