Provider Demographics
NPI:1417420696
Name:CAMPER, MARY A (DD, PHD, LCSW, CADC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:CAMPER
Suffix:
Gender:F
Credentials:DD, PHD, LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17577 KEDZIE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2051
Mailing Address - Country:US
Mailing Address - Phone:815-418-6577
Mailing Address - Fax:
Practice Address - Street 1:401 E 162ND ST STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2237
Practice Address - Country:US
Practice Address - Phone:815-418-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32188101YA0400X
171M00000X, 172A00000X, 172A00000X, 261QM0850X
149.0264151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical