MEDICARE: CONSUELO REDDICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	61047950	WA
2	2084P0800X	Psychiatry Physician	89249	MT
3	2084P0800X	Psychiatry Physician	G133049	CA
4	2084P0804X	Child & Adolescent Psychiatry Physician	MD199050	OR
5	2084P0800X	Psychiatry Physician	61047950	WA
6	2084P0800X	Psychiatry Physician	044067	GA
7	2084P0804X	Child & Adolescent Psychiatry Physician	044067	GA
8	2084P0804X	Child & Adolescent Psychiatry Physician	89249	MT
9	2084P0800X	Psychiatry Physician	MD199050	OR
10	2084P0804X	Child & Adolescent Psychiatry Physician	G133049	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437214350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSUELO REDDICK M.D.

Provider Business Mailing Address
First Line	:	400 UNION AVE SE STE 200
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2060
Country	:	US
Telephone Number	:	833-351-8255
Fax Number	:	888-815-3583

Provider Business Practice Location Address
First Line	:	300 COLONIAL CENTER PKWY STE 100
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4892
Country	:	US
Telephone Number	:	470-670-6319
Fax Number	:	888-815-3583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	02/02/2026

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Directions to “ CONSUELO REDDICK M.D.” Practice Location

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