Healthcare Provider Details

I. General information

NPI: 1053627653
Provider Name (Legal Business Name): ALEXANDER MATTHEW MEYER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6289 W HOWARD ST
NILES IL
60714-3403
US

IV. Provider business mailing address

4153 N BLOOMINGTON AVE 203
ARLINGTON HEIGHTS IL
60004-2070
US

V. Phone/Fax

Practice location:
  • Phone: 847-588-0463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: