| Doctor Name: | MS. JACQUELYN DORN CAMPBELL |
| NPI Number: | 1245506815 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.,L.D. |
| License Number: | DT01962 |
| Business Practice Address: | 522 E Pierce St Luling, TX - 786482613 |
| Business Phone Number: | 8303510566 |
| Business Fax Number: | |
| Mailing Address: | 409 E Jones St, LULING |
| State: | TX |
| Postal Code: | 786481943 |
| Phone Number: | 8308755507 |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2012 |
| NPI Last Update Date: | 03/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | DT01962 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |