Paul C Kredow, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-004395 Issued in IL

Practice address

400 Skokie Blvd Ste 245
Northbrook, IL 60062-7932

Phone

(847) 446-4617

Fax

(847) 446-4673

NPI assigned

Aug 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667088000000",
    "number": "1871502856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SKOKIE BLVD STE 245",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600627932",
            "telephone_number": "847-446-4617",
            "fax_number": "847-446-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SKOKIE BLVD STE 245",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600627932",
            "telephone_number": "847-446-4617",
            "fax_number": "847-446-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREDOW",
        "first_name": "PAUL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2022-10-30",
        "certification_date": "2022-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-004395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 NPI",
            "identifier": "1093030132",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerri Krantz, CCC-SLP
• Maria Kraszynska, M.D.
• Louis James Kraus, M.D.
• Ruth Kraus, PH.D.
• Rachel Kravitz, LCSW
• Marci R Kreiner, MS OTR L
• Anna Lynn Kreiser, MS, RDN, LDN
• Jennifer Risa Krentzman
• Carlie Krider
• Pamela Jeaninne Krolik

• Clinical Psychologist in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.