| NPI | 1093030132 |
|---|---|
| Former Legal Business Name | PRIMARY CARE PSYCHOLOGY ASSOCAITES, LLC |
| Doing Business As | PCPA LEGACY. LLC |
| Entity Type | Organization |
| Authorized Contact | PAUL C KREDOW Provider/Owner 847-630-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-004395) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071-004395) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2023-09-06 |