Provider Demographics
NPI:1992893507
Name:CAMPIDILLI, PATTI ANNE (LISW)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:ANNE
Last Name:CAMPIDILLI
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH B. ST.
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2449
Mailing Address - Country:US
Mailing Address - Phone:515-962-9126
Mailing Address - Fax:515-962-9366
Practice Address - Street 1:100 SOUTH B. STREET
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2449
Practice Address - Country:US
Practice Address - Phone:515-962-9126
Practice Address - Fax:515-962-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07669Medicare ID - Type Unspecified