Healthcare Provider Details

I. General information

NPI: 1265002810
Provider Name (Legal Business Name): KATHRYN D MAROLT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 W CHESTNUT ST STE 100
BURLINGTON WI
53105-1200
US

IV. Provider business mailing address

120 ROBINCREST LN
LINDENHURST IL
60046-9520
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-9191
  • Fax:
Mailing address:
  • Phone: 312-246-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2943-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: