Active NPI
Michelle Campbell, CCC-SLP, BCBA
- Speech-Language Pathologist
- Bluff Dale, TX
National Provider Identifier
1063728558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 17279
- Practice address
- 255 Anglers Ridge
Bluff Dale, TX 76433 - Phone
- (817) 408-8395
- NPI assigned
- Aug 23, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-10-7216 | TX | |
| Speech-Language Pathologist | 235Z00000X | 17279 | TX | Primary |
Addresses
Primary practice location
255 Anglers Ridge
Bluff Dale, TX 76433
Mailing address
PO Box 277
Bluff Dale, TX 76433-0277
Phone (817) 408-8395
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80S906 | Other | TX | BCBS |
| 214308301 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17279 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathways Early Autism Intervention | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Bluff Dale, TX
- NPI 1427322858
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1063728558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 277",
"city": "BLUFF DALE",
"state": "TX",
"postal_code": "764330277",
"telephone_number": "817-408-8395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 ANGLERS RIDGE",
"city": "BLUFF DALE",
"state": "TX",
"postal_code": "76433",
"telephone_number": "817-408-8395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "MICHELLE",
"credential": "CCC-SLP, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-23",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "TX",
"license": "1-10-7216",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "17279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "80S906",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "214308301",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bluff Dale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.