Healthcare Provider Details

I. General information

NPI: 1932202173
Provider Name (Legal Business Name): SANDRA C. REDDEN DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OFFICE PARK CIRCLE SUITE 140
BIRMINGHAM AL
35223
US

IV. Provider business mailing address

15 OFFICE PARK CIRCLE SUITE 104
BIRMINGHAM AL
35223
US

V. Phone/Fax

Practice location:
  • Phone: 205-523-8219
  • Fax: 205-523-8219
Mailing address:
  • Phone: 205-523-8219
  • Fax: 205-523-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1147
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: