Provider Demographics
NPI:1699555771
Name:HAYWOOD, KAMILLE MICHELLE
Entity type:Individual
Prefix:
First Name:KAMILLE
Middle Name:MICHELLE
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 FOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3100
Mailing Address - Country:US
Mailing Address - Phone:708-769-3299
Mailing Address - Fax:
Practice Address - Street 1:942 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-3100
Practice Address - Country:US
Practice Address - Phone:708-769-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108216104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker