Healthcare Provider Details

I. General information

NPI: 1952229247
Provider Name (Legal Business Name): THE CREED COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42W306 RAVINE DR
SAINT CHARLES IL
60175-8269
US

IV. Provider business mailing address

42W306 RAVINE DR
SAINT CHARLES IL
60175-8269
US

V. Phone/Fax

Practice location:
  • Phone: 708-203-0273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER CREED
Title or Position: NURSE PRACTITIONER
Credential: NP-FPA
Phone: 708-203-0273