Healthcare Provider Details

I. General information

NPI: 1689588584
Provider Name (Legal Business Name): AMBER ALICE PITT CREASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N CLYBOURN AVE
CHICAGO IL
60614-4031
US

IV. Provider business mailing address

1765 N ELSTON AVE STE 202
CHICAGO IL
60642-1501
US

V. Phone/Fax

Practice location:
  • Phone: 773-620-7800
  • Fax:
Mailing address:
  • Phone: 773-620-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number103K00000X
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: