Provider Demographics
NPI:1023145349
Name:REEDER, CAROLYN M (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:REEDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COVENTRY LN
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7579
Mailing Address - Country:US
Mailing Address - Phone:815-356-2700
Mailing Address - Fax:815-356-2709
Practice Address - Street 1:500 COVENTRY LN
Practice Address - Street 2:SUITE 170
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7579
Practice Address - Country:US
Practice Address - Phone:815-356-2700
Practice Address - Fax:815-356-2709
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36149Medicare ID - Type Unspecified