NPIMap

Organization Active NPI

Credo Therapy PLLC

  • Hearing and Speech Clinic/Center
  • Mokena, IL
National Provider Identifier
1023888237
Registry record updated Sep 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing and Speech Clinic/CenterTaxonomy code 261QH0700X
Legal business name
CREDO THERAPY PLLC
Practice address
19309 Beaver Creek LN
Mokena, IL 60448-8251
Phone
(708) 650-2106
NPI assigned
Jan 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alicia Marie WallNPI 1114208238
Title
Owner/Speech-Language Pathologist
Phone
(708) 650-2106

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing and Speech Clinic/Center 261QH0700X Primary

Addresses

Primary practice location

19309 Beaver Creek LN
Mokena, IL 60448-8251

Mailing address

19309 Beaver Creek LN
Mokena, IL 60448-8251

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727481600000",
    "number": "1023888237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19309 BEAVER CREEK LN",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19309 BEAVER CREEK LN",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488251",
            "telephone_number": "708-650-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDO THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "708-650-2106"
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.