Provider Demographics
NPI:1376219089
Name:ALRIDGE, KEISHA-MARIE (MA)
Entity Type:Individual
Prefix:
First Name:KEISHA-MARIE
Middle Name:
Last Name:ALRIDGE
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 1:129 N HUMPHREY AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2552
Mailing Address - Country:US
Mailing Address - Phone:817-564-2698
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1622
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3668
Practice Address - Country:US
Practice Address - Phone:224-662-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist