Healthcare Provider Details

I. General information

NPI: 1932690625
Provider Name (Legal Business Name): CAITLIN ANNE REISEL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN PATTERSON

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S SHUMWAY AVE STE 1W
BATAVIA IL
60510-2499
US

IV. Provider business mailing address

30 S SHUMWAY AVE STE 1W
BATAVIA IL
60510-2499
US

V. Phone/Fax

Practice location:
  • Phone: 630-415-7325
  • Fax: 630-937-1153
Mailing address:
  • Phone: 630-415-7325
  • Fax: 630-937-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: