Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071.006914 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.006914 | IL |
NPI | 1013003698 |
---|---|
Provider Name | Dr. Scott Walter Maieritsch |
First Address | Hines, IL 60141-5000 |
Second Address | Hines, IL 60141-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/02/2013 |