MEDICARE: CALICO PSYCHOLOGICAL SERVICES, PLLC

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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1528915808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALICO PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6217 N CAMPBELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2807
Country	:	US
Telephone Number	:	972-365-1866
Fax Number	:	972-365-1866

Provider Business Practice Location Address
First Line	:	6217 N CAMPBELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2807
Country	:	US
Telephone Number	:	972-365-1866
Fax Number	:	972-365-1866

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	KRISTIN RALEY
Credential	:	PHD
Telephone Number	:	972-365-1866

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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