Provider Demographics
NPI:1699088724
Name:CAMPBELL, KRISTEN (SCD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SCD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCD
Mailing Address - Street 1:5 WATKINS RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3836
Mailing Address - Country:US
Mailing Address - Phone:732-598-6554
Mailing Address - Fax:
Practice Address - Street 1:790 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3007
Practice Address - Country:US
Practice Address - Phone:802-847-3970
Practice Address - Fax:802-847-5880
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA0077800231H00000X
NJ25MG00119500237700000X
VT145.0133309231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist