Healthcare Provider Details

I. General information

NPI: 1760736052
Provider Name (Legal Business Name): REID A. KEHOE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 432
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 432
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax: 630-208-3007
Mailing address:
  • Phone: 630-933-4056
  • Fax: 630-208-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071008405
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: