Individual
JENDAYI CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2065 HALF DAY RD, DEERFIELD, IL 60015-1241
(630) 487-9241
Mailing address
589 BLUEBIRD DR, BOLINGBROOK, IL 60440-4878
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XOH846989710
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/13/2017
Last updated
09/13/2017
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