Provider Demographics
NPI:1922131622
Name:REID, VICTORIA (PHD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:REID
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 1:1333 BURR RIDGE PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0833
Mailing Address - Country:US
Mailing Address - Phone:773-320-2700
Mailing Address - Fax:630-756-3001
Practice Address - Street 1:15255 S 94TH AVE
Practice Address - Street 2:STE 500
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3895
Practice Address - Country:US
Practice Address - Phone:708-323-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6973Medicare PIN
ILIL6974Medicare PIN
ILK01710Medicare UPIN