Provider Demographics
NPI:1225375389
Name:CAMPBELL, ROBERT BRUCE (PSYD, MDIV)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PSYD, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1400 RENAISSANCE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1329
Mailing Address - Country:US
Mailing Address - Phone:847-318-8200
Mailing Address - Fax:847-318-9170
Practice Address - Street 1:1400 RENAISSANCE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1329
Practice Address - Country:US
Practice Address - Phone:847-318-8200
Practice Address - Fax:847-318-9170
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical