Provider Demographics
NPI:1366719981
Name:CAMPBELL, STACY L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5712 STABLE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8048
Mailing Address - Country:US
Mailing Address - Phone:843-693-2504
Mailing Address - Fax:
Practice Address - Street 1:4285 WALKER RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-1332
Practice Address - Country:US
Practice Address - Phone:719-827-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4898235Z00000X
COSLP.0003614235Z00000X
VA2202011130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1235Medicaid