Healthcare Provider Details

I. General information

NPI: 1295835205
Provider Name (Legal Business Name): VALERIE M CREEDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE MS 11
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6516
  • Fax: 312-569-6171
Mailing address:
  • Phone: 773-545-1924
  • Fax: 312-569-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150010004
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012515
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: