=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881707149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYDNEY K REED LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 07/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3545 LAKE AVE SUITE 200
-----------------------------------------------------
City | WILMETTE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60091-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-251-7350
-----------------------------------------------------
Fax | 847-853-2600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1151 ASHLAND AVE
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60202-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-866-7357
-----------------------------------------------------
Fax | 847-866-7301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149001345
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------