Individual
LETHA CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
5016 GRIST MILL DR, VILLA RICA, GA 30180-5401
(770) 783-9498
(877) 977-9552
Mailing address
5016 GRIST MILL DR, VILLA RICA, GA 30180-5401
(770) 783-9498
(877) 977-9552
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006046
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100842
TRADING PARTNER
GA
01
—
571152749
BCBS
GA
01
—
786634130A
PEACHSTATE
GA
05
—
786634130A
—
GA
05
—
786634130F
—
GA
01
—
867779344A
PAYEE ID
GA
Enumeration date
12/31/2006
Last updated
02/20/2015
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