Provider Demographics
NPI:1043510746
Name:CAMPBELL, STEPHANIE LYNN (PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4218 N FARM ROAD 79
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9423
Mailing Address - Country:US
Mailing Address - Phone:417-848-8889
Mailing Address - Fax:417-427-6479
Practice Address - Street 1:3734 SOUTH AVE STE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5291
Practice Address - Country:US
Practice Address - Phone:417-848-8889
Practice Address - Fax:417-427-6479
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011010083103K00000X
MO2005038070103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst