Provider Demographics
NPI:1588841720
Name:CREEDON, INGRID (PT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:CREEDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1458
Mailing Address - Country:US
Mailing Address - Phone:708-307-2703
Mailing Address - Fax:708-255-5427
Practice Address - Street 1:3426 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1458
Practice Address - Country:US
Practice Address - Phone:708-307-2703
Practice Address - Fax:708-255-5427
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist