Provider Demographics
NPI:1437214350
Name:REDDICK, CONSUELO (MD)
Entity type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 UNION AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2060
Mailing Address - Country:US
Mailing Address - Phone:833-351-8255
Mailing Address - Fax:888-815-3583
Practice Address - Street 1:300 COLONIAL CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4892
Practice Address - Country:US
Practice Address - Phone:470-670-6319
Practice Address - Fax:888-815-3583
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2025-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0440672084P0804X, 2084P0800X
MT892492084P0804X, 2084P0800X
CAG1330492084P0800X, 2084P0804X
WA610479502084P0804X, 2084P0800X
ORMD1990502084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00024706Medicaid
GAC75884Medicare UPIN
GA26DGJHMedicare ID - Type Unspecified
GA00024706Medicaid