Provider Demographics
NPI:1497295307
Name:KELLY K. SCHILDER, LTD.
Entity Type:Organization
Organization Name:KELLY K. SCHILDER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-505-2755
Mailing Address - Street 1:600 DAVIS ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4488
Mailing Address - Country:US
Mailing Address - Phone:773-505-2755
Mailing Address - Fax:
Practice Address - Street 1:600 DAVIS ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4488
Practice Address - Country:US
Practice Address - Phone:773-505-2755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty