MEDICARE: MEGAN JOY CAMPBELL ATR, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	180.009612	IL

General Provider Information

NPI Number	:	1245616275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN JOY CAMPBELL ATR, LCPC

Provider Business Mailing Address
First Line	:	1380 E ARMOUR RD
Second Line	:
City	:	BOURBONNAIS
State	:	IL
Zip	:	60914-4484
Country	:	US
Telephone Number	:	815-944-2753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2146
Country	:	US
Telephone Number	:	815-944-2753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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