Provider Demographics
NPI:1013639178
Name:KALTEN, AMY (MA; ED S)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KALTEN
Suffix:
Gender:F
Credentials:MA; ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3633
Mailing Address - Country:US
Mailing Address - Phone:630-719-5825
Mailing Address - Fax:
Practice Address - Street 1:6835 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3633
Practice Address - Country:US
Practice Address - Phone:630-719-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
IL2499206103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool