Healthcare Provider Details

I. General information

NPI: 1902102882
Provider Name (Legal Business Name): DEBORAH REED MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTMINSTER STREET SUITE 104
LAKE FOREST IL
60045-2774
US

IV. Provider business mailing address

1 WESTMINSTER STREET SUITE 104
LAKE FOREST IL
60045-2774
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-4248
  • Fax:
Mailing address:
  • Phone: 847-295-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number036069293
License Number StateIL

VIII. Authorized Official

Name: DEBORAH REED
Title or Position: PRESIDENT
Credential: MD
Phone: 847-295-4248