Provider Demographics
NPI:1497219349
Name:ELREDY, CADY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CADY
Middle Name:
Last Name:ELREDY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 NORTH BLVD APT 408
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1242
Mailing Address - Country:US
Mailing Address - Phone:469-777-1133
Mailing Address - Fax:
Practice Address - Street 1:3234 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2594
Practice Address - Country:US
Practice Address - Phone:773-466-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001409171100000X
IL198.001409171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198.001409OtherSTATE OF ILLINOIS DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION