1972589661 NPI number — MRS. CHRISTINE NELLIE TREDUP MSW, ACSW, LCSW, BCD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972589661 NPI number — MRS. CHRISTINE NELLIE TREDUP MSW, ACSW, LCSW, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREDUP
Provider First Name:
CHRISTINE
Provider Middle Name:
NELLIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, ACSW, LCSW, BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972589661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 264
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CHARLES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60174-0264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-377-9939
Provider Business Mailing Address Fax Number:
630-377-9839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 ILLINOIS AVE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
ST CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174-2966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-377-9939
Provider Business Practice Location Address Fax Number:
630-377-9839
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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