Provider Demographics
NPI:1295402022
Name:CREECH, LYDIA GRACE (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:GRACE
Last Name:CREECH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 N MARMORA AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4365
Mailing Address - Country:US
Mailing Address - Phone:312-887-2034
Mailing Address - Fax:
Practice Address - Street 1:310 SOUTH MAIN STREET
Practice Address - Street 2:UNIT D
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-652-0200
Practice Address - Fax:630-652-0300
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist