Provider Demographics
NPI:1316062243
Name:CAMPBELL, MATTHEW STEPHEN (MS, SLP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-0622
Mailing Address - Country:US
Mailing Address - Phone:304-583-8549
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 10 THREE MILE CURVE ROAD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601
Practice Address - Country:US
Practice Address - Phone:304-752-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist