Healthcare Provider Details

I. General information

NPI: 1336527613
Provider Name (Legal Business Name): MATTHEW JOHN LANDSTROM PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 02/07/2021
Certification Date: 02/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 N MEACHAM RD STE 750
SCHAUMBURG IL
60173-4368
US

IV. Provider business mailing address

1933 N MEACHAM RD STE 750
SCHAUMBURG IL
60173-4368
US

V. Phone/Fax

Practice location:
  • Phone: 708-665-5170
  • Fax: 847-906-1086
Mailing address:
  • Phone: 708-665-5170
  • Fax: 847-906-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: