Provider Demographics
NPI:1346783818
Name:CAMPBELL, NANCY M (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 SIX IRON CT
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-6618
Mailing Address - Country:US
Mailing Address - Phone:775-980-9229
Mailing Address - Fax:
Practice Address - Street 1:550 N SHERMAN ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3488
Practice Address - Country:US
Practice Address - Phone:800-973-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist