Provider Demographics
NPI:1427254010
Name:GEORGE FEDEN, PHD
Entity type:Organization
Organization Name:GEORGE FEDEN, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-562-9353
Mailing Address - Street 1:623 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9784
Mailing Address - Country:US
Mailing Address - Phone:815-562-9353
Mailing Address - Fax:
Practice Address - Street 1:623 BEAVER DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9784
Practice Address - Country:US
Practice Address - Phone:815-562-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212441OtherMEDICARE ILLINOIS
IN235340OtherMEDICARE INDIANA