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General NPI Number Information
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NPI Number | 1265002810
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Entity Type | Individual
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Provider Name | KATHRYN D MAROLT PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 197 W CHESTNUT ST STE 100
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City | BURLINGTON
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State | WI
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Zip | 53105-1200
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Country | US
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Telephone | 262-763-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 120 ROBINCREST LN
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City | LINDENHURST
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State | IL
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Zip | 60046-9520
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Country | US
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Telephone | 312-246-2834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2943-57
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License Number State | WI
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