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General NPI Number Information
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NPI Number | 1427254010
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Entity Type | Organization
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Legal Business Name | GEORGE FEDEN, PHD
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 623 BEAVER DR
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City | NAPERVILLE
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State | IL
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Zip | 60563-9784
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Country | US
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Telephone | 815-562-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 623 BEAVER DR
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City | NAPERVILLE
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State | IL
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Zip | 60563-9784
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Country | US
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Telephone | 815-562-9353
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | GEORGE FEDEN
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Credential | PHD
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Telephone | 815-562-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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