Provider Demographics
NPI:1669297297
Name:CAMPAGNA, CYNTHIA ANN (PHD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-0271
Mailing Address - Country:US
Mailing Address - Phone:971-241-3206
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 271
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-0271
Practice Address - Country:US
Practice Address - Phone:971-241-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical