Provider Demographics
NPI:1467649004
Name:REDDY, MEGAN (PHD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 HUBER CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4069
Mailing Address - Country:US
Mailing Address - Phone:815-206-8524
Mailing Address - Fax:
Practice Address - Street 1:77 W WASHINGTON ST STE 1500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3219
Practice Address - Country:US
Practice Address - Phone:773-980-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NE822103T00000X
IL071008608103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health