MEDICARE: DR. BETTY ANNE RILEY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-004797	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AETNA	OTHER	IL	7236348
2	26454300	OTHER	IL	MAGELLAN
3	02221477	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1275758500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTY ANNE RILEY PSY.D.

Provider Business Mailing Address
First Line	:	213 W WESLEY ST STE 105
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-5135
Country	:	US
Telephone Number	:	630-681-1900
Fax Number	:	630-462-7669

Provider Business Practice Location Address
First Line	:	213 W WESLEY ST STE 204
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-5102
Country	:	US
Telephone Number	:	630-681-1900
Fax Number	:	630-462-7669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	04/18/2018

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