Provider Demographics
NPI:1295955334
Name:CAMPBELL, DAWN G (LMT ABMP NCTMB)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:G
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT ABMP NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KNIGHT LANE
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61883
Mailing Address - Country:US
Mailing Address - Phone:217-267-3810
Mailing Address - Fax:217-267-3810
Practice Address - Street 1:12 KNIGHT LANE
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IL
Practice Address - Zip Code:61883
Practice Address - Country:US
Practice Address - Phone:217-267-3810
Practice Address - Fax:217-267-3810
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist