Provider Demographics
NPI:1598197485
Name:REA, CAMILLE ANN (MAMS, CCA)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:ANN
Last Name:REA
Suffix:
Gender:F
Credentials:MAMS, CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S PAULINA ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4353
Mailing Address - Country:US
Mailing Address - Phone:312-996-7546
Mailing Address - Fax:312-413-1157
Practice Address - Street 1:811 S PAULINA ST
Practice Address - Street 2:SUITE 180
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4353
Practice Address - Country:US
Practice Address - Phone:312-996-7546
Practice Address - Fax:312-413-1157
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCCA06-51229N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist