Healthcare Provider Details

I. General information

NPI: 1962438242
Provider Name (Legal Business Name): JODY REED, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 N BROADWAY ST APT 3H
CHICAGO IL
60640-1732
US

IV. Provider business mailing address

5427 N BROADWAY ST APT 3H
CHICAGO IL
60640-1732
US

V. Phone/Fax

Practice location:
  • Phone: 780-873-9059
  • Fax: 708-428-4504
Mailing address:
  • Phone: 780-873-9059
  • Fax: 708-428-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071006493
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071007041
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-011714
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-012557
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006912
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036112289
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-001161
License Number StateIL

VIII. Authorized Official

Name: DR. JODY REED
Title or Position: OWNER
Credential: MD
Phone: 708-873-9059