Provider Demographics
NPI:1487952487
Name:CAMPBELL, BRIAN PETER (MA CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PETER
Last Name:CAMPBELL
Suffix:
Gender:M
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 1:145 KALERS CORNER ST
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6001
Mailing Address - Country:US
Mailing Address - Phone:207-832-2103
Mailing Address - Fax:
Practice Address - Street 1:145 KALERS CORNER ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6001
Practice Address - Country:US
Practice Address - Phone:207-832-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist