Organization
SUMMIT CLINICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL R WYMA MD (OWNER)
(630) 260-0606
Entity
Organization
Contact information
Practice address
1761 S NAPERVILLE RD STE 200, WHEATON, IL 60189-5846
(630) 260-0606
(630) 260-1049
Mailing address
1761 S NAPERVILLE RD STE 200, WHEATON, IL 60189-5846
(630) 260-0606
(630) 260-1049
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
071007924
IL
101Y00000X
Counselor
149014503
IL
101Y00000X
Counselor
180004554
IL
101YP2500X
Professional Counselor
180002875
IL
101YP2500X
Professional Counselor
180004799
IL
103TC0700X
Clinical Psychologist
071003388
IL
103TC0700X
Clinical Psychologist
071005180
IL
104100000X
Social Worker
149000008
IL
1041C0700X
Clinical Social Worker
149003718
IL
1041C0700X
Clinical Social Worker
149006444
IL
106H00000X
Marriage & Family Therapist
166000545
IL
2084P0800X
Psychiatry Physician
036063557
IL
2084P0800X
Psychiatry Physician
036089544
IL
2084P0800X
Psychiatry Physician
036124166
IL
2084P0800X
Psychiatry Physician
036128880
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002220764
ILLINOIS BLUE CROSS ID #
IL
Enumeration date
03/20/2007
Last updated
03/14/2013
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