MEDICARE: CHRISTOPHER M CRIDDELL JR. MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1033832357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER M CRIDDELL JR. MSW

Provider Business Mailing Address
First Line	:	4534 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3027
Country	:	US
Telephone Number	:	773-254-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3027
Country	:	US
Telephone Number	:	773-254-5141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	12/21/2022

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