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NPI Code Detail

MEDICARE: KELLY O REID LCSW

MEDICARE: KELLY O REID LCSW
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
11041C0700XClinical Social WorkerIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10032244312OTHERILBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1881708311
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY O REID LCSW
Provider Business Mailing Address
First Line : 1017 PLUM HOLLOW CT
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-2302
Country : US
Telephone Number : 630-784-4839
Fax Number : 630-682-5276
Provider Business Practice Location Address
First Line : 222 E WILLOW AVE
Second Line :
City : WHEATON
State : IL
Zip : 60187-5426
Country : US
Telephone Number : 630-784-4839
Fax Number : 630-682-5276
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/09/2007

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