MEDICARE: PATTI ANNE CAMPIDILLI LISW

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	101YM0800X	Mental Health Counselor	00671	IA

General Provider Information

NPI Number	:	1992893507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTI ANNE CAMPIDILLI LISW

Provider Business Mailing Address
First Line	:	100 SOUTH B. ST.
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-2449
Country	:	US
Telephone Number	:	515-962-9126
Fax Number	:	515-962-9366

Provider Business Practice Location Address
First Line	:	100 SOUTH B. STREET
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-2449
Country	:	US
Telephone Number	:	515-962-9126
Fax Number	:	515-962-9366

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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