Provider Demographics
NPI:1407923097
Name:CREEDON, HUGH P (PHD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:P
Last Name:CREEDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N CLARK ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4613
Mailing Address - Country:US
Mailing Address - Phone:773-868-0272
Mailing Address - Fax:773-868-9870
Practice Address - Street 1:2141 N CLARK ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4613
Practice Address - Country:US
Practice Address - Phone:773-868-0272
Practice Address - Fax:773-868-9870
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-001435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL973770Medicare ID - Type UnspecifiedMEDICARE NUMBER