Provider Demographics
NPI:1902027592
Name:REIDY, BRITTNEY DANIELLE BAIRD (CCC-A)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:DANIELLE BAIRD
Last Name:REIDY
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:DANIELLE
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19662
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9662
Mailing Address - Country:US
Mailing Address - Phone:217-545-6099
Mailing Address - Fax:217-545-0253
Practice Address - Street 1:301 N 8TH ST
Practice Address - Street 2:PAV 5B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701
Practice Address - Country:US
Practice Address - Phone:217-545-6099
Practice Address - Fax:217-545-0253
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-001220231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
K38171Medicare ID - Type Unspecified