Provider Demographics
NPI:1871502856
Name:KREDOW, PAUL C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:KREDOW
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SKOKIE BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7932
Mailing Address - Country:US
Mailing Address - Phone:847-446-4617
Mailing Address - Fax:847-446-4673
Practice Address - Street 1:400 SKOKIE BLVD STE 245
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7932
Practice Address - Country:US
Practice Address - Phone:847-446-4617
Practice Address - Fax:847-446-4673
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093030132OtherTYPE 2 NPI