Provider Demographics
NPI:1881022432
Name:CAMPBELL, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LATHROP AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1289
Mailing Address - Country:US
Mailing Address - Phone:715-977-0476
Mailing Address - Fax:
Practice Address - Street 1:216 LATHROP AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1289
Practice Address - Country:US
Practice Address - Phone:715-977-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst