Individual
KELLY PHIPPS MAIERITSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5TH & ROOSEVELT RD, HINES, IL 60141
(708) 202-8387
Mailing address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-8387
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2004028685
MO
Other
Enumeration date
04/19/2006
Last updated
02/28/2013
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