Pcpa Legacy, LLC
NPI 1093030132ActiveOrganization· Psychologist, Clinical· Northbrook, IL
Psychologist, Clinical in Northbrook, Illinois, registered in NPPES in April 2010. The authorized official on file is Paul C. Kredow, PSYD, Provider/Owner.
Overview
| NPI | 1093030132 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 1, 2010 |
| Last updated in NPPES | Sep 6, 2023 |
| Certified by provider | Oct 27, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | 071-004395 | IL |
| Psychologist, Clinical Child & Adolescent | 103TC2200X | 071-004395 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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