Provider Demographics
NPI:1073629481
Name:KREPS, NICOLE NOELLE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NOELLE
Last Name:KREPS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1931
Mailing Address - Country:US
Mailing Address - Phone:708-212-1769
Mailing Address - Fax:
Practice Address - Street 1:10409 S ROBERTS RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1931
Practice Address - Country:US
Practice Address - Phone:630-323-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000893231H00000X
FLAY 1507231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNW56170900POtherEI
ILNW56170900POtherEI
IL$$$$$$$$$001Medicaid
ILK25431Medicare ID - Type Unspecified
IL709560Medicare UPIN