Provider Demographics
NPI:1891146627
Name:CAMPBELL, ABBY (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:ELIZABETH
Other - Last Name:MANIGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:149 S EDGELAWN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4509
Mailing Address - Country:US
Mailing Address - Phone:815-488-9727
Mailing Address - Fax:
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9893
Practice Address - Country:US
Practice Address - Phone:630-519-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0171191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical