Campbell, Autumn Brooke
Campbell, Autumn Brooke is an sole proprietor health care provider with primary practice located at 5316 Trail Lake Dr , Fort Worth TX 76133-1931. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Assistant, which is considered as her primary health care specialty. Campbell, Autumn Brooke can be contacted via phone (817) 292-8787.Contact Information
Primary practice address
5316 Trail Lake Dr
Fort Worth TX 76133-1931
Phone: (817) 292-8787
Fax: (817) 789-6849
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Assistant | 2355S0801X | 34684 | Texas |
Profile Details
| NPI number | 1619275872 |
|---|---|
| LBN Legal business name | Campbell, Autumn Brooke |
| Credentials | SLPA |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 11th, 2011 |
| Last updated | Mar 15th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619275872 | NPPES |
| Texas | MEDICAID | 149984001 | |
| Texas | MEDICAID | 207164901 |
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