Organization
PCPA LEGACY, LLC
Active
Other names
PCPA LEGACY. LLC, Primary Care Psychology Assocaites, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL C KREDOW PSYD (PROVIDER/OWNER)
(847) 630-1611
Entity
Organization
Contact information
Practice address
400 SKOKIE BLVD STE 245, NORTHBROOK, IL 60062-7932
(847) 630-1611
(847) 446-4673
Mailing address
400 SKOKIE BLVD STE 245, NORTHBROOK, IL 60062-7932
(847) 630-1611
(847) 446-4673
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-004395
IL
103TC2200X
Clinical Child & Adolescent Psychologist
071-004395
IL
Other
Enumeration date
04/01/2010
Last updated
09/06/2023
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