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General NPI Number Information
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NPI Number | 1508632506
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Entity Type | Individual
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Provider Name | JESSICA CREIDLER LPC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 312 HYDE PARK
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City | DOYLESTOWN
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State | PA
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Zip | 18902-6605
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Country | US
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Telephone | 215-345-5083
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Fax |
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Provider Business Mailing Address
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Address Line | 178 ELEPHANT RD APT B22
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City | DUBLIN
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State | PA
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Zip | 18917-2218
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Country | US
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Telephone | 215-622-1554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC016035
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License Number State | PA
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