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NPI Code Detail

MEDICARE: DR. PATRICIA M KOLTUN PSY.D.

MEDICARE: DR. PATRICIA M KOLTUN PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0700XAdult Development & Aging Psychologist071-007480IL
2103T00000XPsychologist
3103TC2200XClinical Child & Adolescent Psychologist071-007480IL
4103T00000XPsychologist071-007480IL

General Provider Information

NPI Number : 1417112863
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICIA M KOLTUN PSY.D.
Provider Business Mailing Address
First Line : PO BOX 234
Second Line :
City : HUNTLEY
State : IL
Zip : 60142-0234
Country : US
Telephone Number : 815-245-7067
Fax Number :
Provider Business Practice Location Address
First Line : 1000 HART RD STE 130
Second Line :
City : BARRINGTON
State : IL
Zip : 60010-2668
Country : US
Telephone Number : 815-245-7067
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2008
Last Update Date : 11/17/2023

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