Provider Demographics
NPI:1053614784
Name:VEED, GLEN J (PHD)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:J
Last Name:VEED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 BOND ST
Mailing Address - Street 2:SUITE 127
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2388
Mailing Address - Country:US
Mailing Address - Phone:630-355-9002
Mailing Address - Fax:866-441-1136
Practice Address - Street 1:1415 BOND ST
Practice Address - Street 2:SUITE 127
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2388
Practice Address - Country:US
Practice Address - Phone:630-355-9002
Practice Address - Fax:866-441-1136
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071.008040103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent