Healthcare Provider Details

I. General information

NPI: 1255258935
Provider Name (Legal Business Name): MARIE ALISON EDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E STONE CT
ADDISON IL
60101-5903
US

IV. Provider business mailing address

810 E STONE CT
ADDISON IL
60101-5903
US

V. Phone/Fax

Practice location:
  • Phone: 779-221-7599
  • Fax:
Mailing address:
  • Phone: 779-221-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: