Provider Demographics
NPI:1932271939
Name:REEDY, YVONNE B (PA LICENSE # PS00821)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:B
Last Name:REEDY
Suffix:
Gender:F
Credentials:PA LICENSE # PS00821
Other - Prefix:DR
Other - First Name:YVONNE
Other - Middle Name:LEE
Other - Last Name:REEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1165 PHILIPSBURG BIGLER HWY
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-8251
Mailing Address - Country:US
Mailing Address - Phone:814-937-0668
Mailing Address - Fax:814-342-2532
Practice Address - Street 1:1165 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8251
Practice Address - Country:US
Practice Address - Phone:814-937-0668
Practice Address - Fax:814-342-2532
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008217L103TC1900X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022904950001Medicaid
PA1022904950001Medicaid