Provider Demographics
NPI:1386847671
Name:MCCRAY, JO LYNN (CDS)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:LYNN
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 W WINONA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3126
Mailing Address - Country:US
Mailing Address - Phone:773-334-6179
Mailing Address - Fax:
Practice Address - Street 1:1057 W WINONA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3126
Practice Address - Country:US
Practice Address - Phone:773-334-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist