Provider Demographics
NPI:1225766637
Name:KAELTER, MARISSA ESTHER (EDS, MED, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:ESTHER
Last Name:KAELTER
Suffix:
Gender:F
Credentials:EDS, MED, NCSP
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:ESTHER
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCSP
Mailing Address - Street 1:1945 CAVELL AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2216
Mailing Address - Country:US
Mailing Address - Phone:773-484-3391
Mailing Address - Fax:
Practice Address - Street 1:2400 RAVINE WAY STE 600
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7615
Practice Address - Country:US
Practice Address - Phone:847-730-3042
Practice Address - Fax:847-730-3382
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty