Ilana Craddock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014751 Issued in IL

Practice address

411 E Washington St
East Peoria, IL 61611-2663

Phone

(309) 282-6704

Fax

(309) 387-2340

NPI assigned

Aug 24, 2016

Last updated

Aug 24, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ilana Derenfeld Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mueller Pediatric Therapy LTD

  • Speech-Language Pathologist
  • East Peoria, IL
  • NPI 1801289723

  Clinical

  NPD (past)
• Mueller Pediatric Therapy, LTD.

  • Speech-Language Pathologist
  • East Peoria, IL
  • NPI 1316112139
  NPD (past)

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

{
    "created_epoch": "1471996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1356896930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 JADENS WAY",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615714601",
            "telephone_number": "847-909-5457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E WASHINGTON ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112663",
            "telephone_number": "309-282-6704",
            "fax_number": "309-387-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADDOCK",
        "first_name": "ILANA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-24",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ILANA",
            "last_name": "DERENFELD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melanie Coppenbarger, PHARMD
• Costco Wholesale Corporation (Costco Hearing Aid #1126)
• Costco Wholesale Corporation
• Costco Wholesale Corporation (Costco Optical #1126)
• Tiffany Costello
• Karen Lynne Cramer, OD
• Kelli Marie Crawford, L-316360
• Curts Transportation Services LLC
• Bradley A Davis, D.C.
• Rita M Demask, RDH, PHDH

• Clinical Social Worker in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; 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.