Provider Demographics
NPI:1982698833
Name:CHAMPINE, JON-PAUL (PSYD)
Entity type:Individual
Prefix:DR
First Name:JON-PAUL
Middle Name:
Last Name:CHAMPINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PARK DR STE 6
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1094
Mailing Address - Country:US
Mailing Address - Phone:847-571-4985
Mailing Address - Fax:
Practice Address - Street 1:503 PARK DR STE 6
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1094
Practice Address - Country:US
Practice Address - Phone:847-571-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210025Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST