Provider Demographics
NPI:1285138115
Name:CAMPBELL, ELIZABETH JOYCE (SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOYCE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20970 PROMONTORY SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7211
Mailing Address - Country:US
Mailing Address - Phone:571-388-8045
Mailing Address - Fax:
Practice Address - Street 1:41535 SACRED MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5533
Practice Address - Country:US
Practice Address - Phone:703-722-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01081859OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
VA2202002009OtherDEPARTMENT OF HEALTH PROFESSIONS