Physician Compare National (NPI:1184730764)

HEALTHCARE PROVIDER: LISA CECILIA CAMPBELL PSY.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1184730764
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608779111
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040131000040
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CAMPBELL
	Individual professional last name
Provider First Name	LISA
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	CP
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WILLOW WELLNESS CENTER, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	0941275267
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1400 RENAISSANCE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 401
	Group Practice or individual's line 2 address
City	PARK RIDGE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600681337
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8473188200
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y