Individual
LASHAE CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3 WILDWOOD LANE G, BOLINGBROOK, IL 60440-1942
(708) 916-1128
Mailing address
3 WILDWOOD LANE G, BOLINGBROOK, IL 60440-1942
(708) 916-1128
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/08/2019
Last updated
04/08/2019
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