Healthcare Provider Details

I. General information

NPI: 1629997051
Provider Name (Legal Business Name): ELLEN FAY GEDDES PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 S 75TH AVE FL 3
PALOS HEIGHTS IL
60463-1033
US

IV. Provider business mailing address

2736 N HAMPDEN CT APT 201
CHICAGO IL
60614-1635
US

V. Phone/Fax

Practice location:
  • Phone: 708-726-6472
  • Fax:
Mailing address:
  • Phone: 480-980-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.022710
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: