Provider Demographics
NPI:1871120048
Name:CAMPBELL, BENJAMIN LEE (MSW)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 W 6TH AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17330 135TH AVE NE STE 2B
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8522
Practice Address - Country:US
Practice Address - Phone:425-998-9769
Practice Address - Fax:844-837-1339
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW614454171041C0700X
WA61034407104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker