Provider Demographics
NPI:1164646980
Name:MEADE, ALICIA T (MA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:T
Last Name:MEADE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3414
Mailing Address - Country:US
Mailing Address - Phone:708-305-3305
Mailing Address - Fax:708-660-0174
Practice Address - Street 1:1142 CHICAGO AVE
Practice Address - Street 2:W2
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1837
Practice Address - Country:US
Practice Address - Phone:708-305-3305
Practice Address - Fax:708-660-0174
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635191Medicare UPIN