Provider Demographics
NPI:1932202173
Name:REDDEN, SANDRA C (DR)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:C
Last Name:REDDEN
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OFFICE PARK CIRCLE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223
Mailing Address - Country:US
Mailing Address - Phone:205-523-8219
Mailing Address - Fax:205-523-8219
Practice Address - Street 1:15 OFFICE PARK CIRCLE
Practice Address - Street 2:SUITE 140
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223
Practice Address - Country:US
Practice Address - Phone:205-523-8219
Practice Address - Fax:205-523-8219
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1147103TM1800X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-28851OtherBCBS OF AL PROVIDER #
AL139124Medicaid