Provider Demographics
NPI:1972589661
Name:TREDUP, CHRISTINE NELLIE (MSW, ACSW, LCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NELLIE
Last Name:TREDUP
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-0264
Mailing Address - Country:US
Mailing Address - Phone:630-377-9939
Mailing Address - Fax:630-377-9839
Practice Address - Street 1:409 ILLINOIS AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2966
Practice Address - Country:US
Practice Address - Phone:630-377-9939
Practice Address - Fax:630-377-9839
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL960440Medicare ID - Type Unspecified