Provider Demographics
NPI:1285872366
Name:REID, CAROL ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:REID
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3033
Mailing Address - Country:US
Mailing Address - Phone:708-261-5198
Mailing Address - Fax:
Practice Address - Street 1:5500 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1357
Practice Address - Country:US
Practice Address - Phone:630-377-3535
Practice Address - Fax:630-530-9527
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical