Provider Demographics
NPI:1447812193
Name:REDDICK, ANJAIL (MS)
Entity type:Individual
Prefix:MS
First Name:ANJAIL
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ANTLERS LANE
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1805
Mailing Address - Country:US
Mailing Address - Phone:215-989-2005
Mailing Address - Fax:
Practice Address - Street 1:123 ANTLERS LN
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2770
Practice Address - Country:US
Practice Address - Phone:215-989-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health