Individual
DR. GEORGE FEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-9567
Mailing address
623 BEAVER DR, NAPERVILLE, IL 60563-9784
(630) 579-4363
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004362
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091880
—
IN
01
—
250330
MEDICARE B INDIANA
IN
Enumeration date
07/31/2006
Last updated
05/09/2018
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