Provider Demographics
NPI:1699939207
Name:REED, ROXY LYNN (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ROXY
Middle Name:LYNN
Last Name:REED
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-2319
Mailing Address - Country:US
Mailing Address - Phone:217-431-5484
Mailing Address - Fax:217-431-8532
Practice Address - Street 1:105 W ROSELAWN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-2319
Practice Address - Country:US
Practice Address - Phone:217-431-5484
Practice Address - Fax:217-431-8532
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid