Provider Demographics
NPI:1730363706
Name:CAMPBELL, KELLY ANNE (SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11047 NORTH 79TH PLACE
Mailing Address - Street 2:THERAPY TIME SPEECH LANGUAGE THERAPY
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-619-6061
Mailing Address - Fax:480-998-8215
Practice Address - Street 1:11047 NORTH 79TH PLACE
Practice Address - Street 2:THERAPY TIME SPEECH LANGUAGE THERAPY
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:602-619-6061
Practice Address - Fax:480-998-8215
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5688235Z00000X
OHSP-5902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist