Provider Demographics
NPI:1902519457
Name:CAMPBELL, GIAH LAUREN
Entity Type:Individual
Prefix:
First Name:GIAH
Middle Name:LAUREN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8052
Mailing Address - Country:US
Mailing Address - Phone:612-470-3408
Mailing Address - Fax:
Practice Address - Street 1:7035 BERKSHIRE LN
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8052
Practice Address - Country:US
Practice Address - Phone:323-877-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN135946700020171M00000X
MN8589503172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator