Healthcare Provider Details

I. General information

NPI: 1295309326
Provider Name (Legal Business Name): MATTHEW FLEMING PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 MERCHANT DR STE C&F
ALGONQUIN IL
60102-5917
US

IV. Provider business mailing address

22466 N HOPEWELL CT
KILDEER IL
60047-7925
US

V. Phone/Fax

Practice location:
  • Phone: 847-461-8414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010972
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178009612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: