Healthcare Provider Details

I. General information

NPI: 1245451137
Provider Name (Legal Business Name): CAROLYN M CAMPBELL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 W IRVING PARK RD E8
CHICAGO IL
60613-3159
US

IV. Provider business mailing address

684 W IRVING PARK RD E8
CHICAGO IL
60613-3159
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-8725
  • Fax:
Mailing address:
  • Phone: 773-472-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name: CAROLYN M CAMPBELL
Title or Position: OWNER
Credential: MSW,ACSW,BCD,LCSW
Phone: 773-472-8725