JACQUELINE M CHAMPLAIN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****14

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Middle

Last Name

CHAMPLAIN

Business Name

JACQUELINE M CHAMPLAIN

Original Issue Date

11/14/2013

Effective Date

08/12/2014

Expiration Date

07/31/2017

City

HINSDALE

State

Zip

60521

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017