Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301010948 | MI |
NPI | 1073952594 |
---|---|
Provider Name | Anne E Campbell |
First Address | Farmington, MI 48335-4163 |
Second Address | Commerce Twp, MI 48382-4485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 18/06/2013 |