Organization
LAYNIE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUMMER A MATHESON PHD (C.O.O.)
(708) 617-8548
Entity
Organization
Contact information
Practice address
4747 LINCOLN MALL DR, SUITE 604, MATTESON, IL 60443-3811
(708) 617-8548
(708) 617-8017
Mailing address
4747 LINCOLN MALL DR, SUITE 604, MATTESON, IL 60443-3811
(708) 617-8548
(708) 617-8017
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790076628
—
IL
Enumeration date
04/02/2013
Last updated
04/02/2013
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