Provider Demographics
NPI:1518082502
Name:SUMMIT CLINICAL SERVICES PC
Entity Type:Organization
Organization Name:SUMMIT CLINICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WYMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-260-0606
Mailing Address - Street 1:1761 S NAPERVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5846
Mailing Address - Country:US
Mailing Address - Phone:630-260-0606
Mailing Address - Fax:630-260-1049
Practice Address - Street 1:1761 S NAPERVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5846
Practice Address - Country:US
Practice Address - Phone:630-260-0606
Practice Address - Fax:630-260-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004554101Y00000X
IL071007924101Y00000X
IL149014503101Y00000X
IL180002875101YP2500X
IL180004799101YP2500X
IL071003388103TC0700X
IL071005180103TC0700X
IL149000008104100000X
IL1490064441041C0700X
IL1490037181041C0700X
IL166000545106H00000X
IL0360635572084P0800X
IL0360895442084P0800X
IL0361241662084P0800X
IL0361288802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002220764OtherILLINOIS BLUE CROSS ID #
IL342160Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER