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NPI Code Detail

MEDICARE: JOSEPH P CROEGAERT MSW, LCSW

MEDICARE: JOSEPH P CROEGAERT MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1113255OTHERILHEALTH ALLIANCE ID
2IL0119 FOR 371337853OTHERILID FOR JOHN DEERE HEALTH

General Provider Information

NPI Number : 1770663908
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH P CROEGAERT MSW, LCSW
Provider Business Mailing Address
First Line : 3020 W WILLOW KNOLLS DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-8127
Country : US
Telephone Number : 309-681-5850
Fax Number : 309-681-5658
Provider Business Practice Location Address
First Line : 3020 W WILLOW KNOLLS DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-8127
Country : US
Telephone Number : 309-681-5850
Fax Number : 309-681-5658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/08/2007

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