Provider Demographics
NPI:1790123222
Name:REDDICK, ALISON RUTH (ATC/L, CSCS)
Entity Type:Individual
Prefix:MISS
First Name:ALISON
Middle Name:RUTH
Last Name:REDDICK
Suffix:
Gender:F
Credentials:ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ILLINOIS STATE UNIVERSITY
Mailing Address - Street 2:CAMPUS BOX 7160
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-7160
Mailing Address - Country:US
Mailing Address - Phone:309-438-3340
Mailing Address - Fax:
Practice Address - Street 1:ILLINOIS STATE UNIVERSITY
Practice Address - Street 2:CAMPUS BOX 7160
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-7160
Practice Address - Country:US
Practice Address - Phone:309-438-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960035352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer