Provider Demographics
NPI:1174889828
Name:CAMPBELL, KELLY ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-8650
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:4201 TUDOR CENTRE DR
Practice Address - Street 2:SUITE #300
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-8650
Practice Address - Fax:907-729-8607
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical