Provider Demographics
NPI:1942558655
Name:LADD, AIMEE JEANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:JEANNETTE
Last Name:LADD
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 1:1003 N CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9646
Mailing Address - Country:US
Mailing Address - Phone:309-444-1000
Mailing Address - Fax:309-444-7000
Practice Address - Street 1:1003 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9646
Practice Address - Country:US
Practice Address - Phone:309-444-1000
Practice Address - Fax:309-444-7000
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical