1225766637 NPI number — MRS. MARISSA ESTHER KAELTER ED.S., M.ED., NCSP

Table of content: MRS. MARISSA ESTHER KAELTER ED.S., M.ED., NCSP (NPI 1225766637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225766637 NPI number — MRS. MARISSA ESTHER KAELTER ED.S., M.ED., NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAELTER
Provider First Name:
MARISSA
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S., M.ED., NCSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNEIDER
Provider Other First Name:
MARISSA
Provider Other Middle Name:
ESTHER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., NCSP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225766637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 CAVELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035-2216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-484-3391
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 RAVINE WAY STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025-7615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-730-3042
Provider Business Practice Location Address Fax Number:
847-730-3382
Provider Enumeration Date:
08/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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