Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003180753 |
---|---|
Provider Name | Mrs. Patrice Louise Campbell |
First Address | Waukegan, IL 60085-2321 |
Second Address | Waukegan, IL 60085-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2012 |
Last Update Date | 28/02/2012 |