Healthcare Provider Details

I. General information

NPI: 1023936986
Provider Name (Legal Business Name): JUDE SULLIVAN CAMPBELL LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

IV. Provider business mailing address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-6000
  • Fax: 269-373-4951
Mailing address:
  • Phone: 269-373-6000
  • Fax: 269-373-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68551121808
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: