Healthcare Provider Details

I. General information

NPI: 1902530280
Provider Name (Legal Business Name): KELSEY CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 MIDLETON LN
MCHENRY IL
60050-8056
US

IV. Provider business mailing address

6419 MIDLETON LN
MCHENRY IL
60050-8056
US

V. Phone/Fax

Practice location:
  • Phone: 224-908-0240
  • Fax:
Mailing address:
  • Phone: 908-224-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: