Provider Demographics
NPI:1598438608
Name:WEITERSCHAN, KARI ALYSSE (PHD)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:ALYSSE
Last Name:WEITERSCHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 N 1ST BANK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8102
Mailing Address - Country:US
Mailing Address - Phone:312-945-7566
Mailing Address - Fax:
Practice Address - Street 1:579 N 1ST BANK DR STE 150
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8102
Practice Address - Country:US
Practice Address - Phone:312-945-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical