Healthcare Provider Details

I. General information

NPI: 1689218711
Provider Name (Legal Business Name): KATHERINE CAMPBELL PHD, LCPC, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10526 W CERMAK RD SUITE 308AA
WESTCHESTER IL
60154
US

IV. Provider business mailing address

10526 W CERMAK RD SUITE 308 AA
WESTCHESTER IL
60154
US

V. Phone/Fax

Practice location:
  • Phone: 872-444-6594
  • Fax:
Mailing address:
  • Phone: 312-502-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009238
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2018489
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: