Healthcare Provider Details

I. General information

NPI: 1922930304
Provider Name (Legal Business Name): AIDAN JAMES CREAMER AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 2ND ST STE 201
SPRINGFIELD IL
62704-7909
US

IV. Provider business mailing address

901 S 2ND ST STE 201
SPRINGFIELD IL
62704-7909
US

V. Phone/Fax

Practice location:
  • Phone: 877-674-1211
  • Fax:
Mailing address:
  • Phone: 877-674-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.012366
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: