Healthcare Provider Details

I. General information

NPI: 1831836220
Provider Name (Legal Business Name): ELIZABETH C CAMPBELL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIZZY CAMPBELL

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 CHARTRES ST
LA SALLE IL
61301-1107
US

IV. Provider business mailing address

618 N 2ND ST
CHILLICOTHEE IL
61523-2130
US

V. Phone/Fax

Practice location:
  • Phone: 815-780-8765
  • Fax:
Mailing address:
  • Phone: 309-857-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2501856
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150105648
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: