Provider Demographics
NPI:1629857917
Name:CRUITT, MICHELLE N (HID)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:N
Last Name:CRUITT
Suffix:
Gender:F
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E ONTARIO ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-263-7171
Mailing Address - Fax:
Practice Address - Street 1:120 OAKBROOK CENTER
Practice Address - Street 2:SUITE 709
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:312-263-7171
Practice Address - Fax:312-263-5410
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3560231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist