Provider Demographics
NPI:1275758500
Name:RILEY, BETTY ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ANNE
Last Name:RILEY
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 1:213 W WESLEY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5135
Mailing Address - Country:US
Mailing Address - Phone:630-681-1900
Mailing Address - Fax:630-462-7669
Practice Address - Street 1:213 W WESLEY ST STE 204
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5102
Practice Address - Country:US
Practice Address - Phone:630-681-1900
Practice Address - Fax:630-462-7669
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAETNAOther7236348
IL26454300OtherMAGELLAN
IL02221477OtherBLUE CROSS BLUE SHIELD
IL201718Medicare ID - Type Unspecified