Provider Demographics
NPI:1114256526
Name:CAMPEAU, JAMIE RENEE (LMSW, CCS,CAADC, ADS)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:RENEE
Last Name:CAMPEAU
Suffix:
Gender:F
Credentials:LMSW, CCS,CAADC, ADS
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:RENEE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2615 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1654
Mailing Address - Country:US
Mailing Address - Phone:269-343-1651
Mailing Address - Fax:269-459-9791
Practice Address - Street 1:2615 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1654
Practice Address - Country:US
Practice Address - Phone:269-343-1651
Practice Address - Fax:269-459-9791
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010914041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114256526Medicaid
MI1114256526Medicaid