Provider Demographics
NPI:1497901193
Name:MATSEY, LYNJUNITA LOEESE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNJUNITA
Middle Name:LOEESE
Last Name:MATSEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:LYNJUNITA
Other - Middle Name:LOEESE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12857 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2049
Mailing Address - Country:US
Mailing Address - Phone:312-391-9013
Mailing Address - Fax:
Practice Address - Street 1:12857 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2049
Practice Address - Country:US
Practice Address - Phone:312-391-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.010643104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker