MEDICARE: MRS. MONIQUE R CAMPBELL-ALLEN CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	22138	IL

General Provider Information

NPI Number	:	1427177674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONIQUE R CAMPBELL-ALLEN CADC

Provider Business Mailing Address
First Line	:	1140 PEACH TREE LANE UNIT K
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-4803
Country	:	US
Telephone Number	:	847-930-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 VARSITY DRIVE
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-8176
Country	:	US
Telephone Number	:	847-741-2600
Fax Number	:	847-741-3248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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