Provider Demographics
NPI:1124034665
Name:CAMPBELL, COLLEEN J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WALKUP AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4383
Mailing Address - Country:US
Mailing Address - Phone:815-455-2020
Mailing Address - Fax:815-455-2021
Practice Address - Street 1:100 N WALKUP AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4383
Practice Address - Country:US
Practice Address - Phone:815-455-2020
Practice Address - Fax:815-455-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490011441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical