MEDICARE: MS. VERONICA MEGAN RAEDY

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1457684771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VERONICA MEGAN RAEDY

Provider Business Mailing Address
First Line	:	2750 HOLLY HALL ST
Second Line	:	APT 202
City	:	HOUSTON
State	:	TX
Zip	:	77054-4109
Country	:	US
Telephone Number	:	864-356-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 HOLLY HALL ST
Second Line	:	APT 202
City	:	HOUSTON
State	:	TX
Zip	:	77054-4109
Country	:	US
Telephone Number	:	864-356-3364
Fax Number	:

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

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	09/18/2009

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