Healthcare Provider Details

I. General information

NPI: 1366775256
Provider Name (Legal Business Name): MATTHEW DAVID LAUER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 10/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 W RENWICK RD STE 204A
PLAINFIELD IL
60544-8733
US

IV. Provider business mailing address

112 OLESEN DR APT 100
NAPERVILLE IL
60540-5862
US

V. Phone/Fax

Practice location:
  • Phone: 815-676-4688
  • Fax: 815-676-4498
Mailing address:
  • Phone: 302-632-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008732
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: