Provider Demographics
NPI:1457684771
Name:RAEDY, VERONICA MEGAN
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MEGAN
Last Name:RAEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 HOLLY HALL ST
Mailing Address - Street 2:APT 202
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4109
Mailing Address - Country:US
Mailing Address - Phone:864-356-3364
Mailing Address - Fax:
Practice Address - Street 1:2750 HOLLY HALL ST
Practice Address - Street 2:APT 202
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4109
Practice Address - Country:US
Practice Address - Phone:864-356-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist