1588287718 NPI number — DOROTHY BUTLER-SOLOMON MS.,QMHP

Table of content: DOROTHY BUTLER-SOLOMON MS.,QMHP (NPI 1588287718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588287718 NPI number — DOROTHY BUTLER-SOLOMON MS.,QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER-SOLOMON
Provider First Name:
DOROTHY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS.,QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTLER-SOLOMON
Provider Other First Name:
DOROTHY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS.,QMHP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588287718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 SOUTHWICK DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTESON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60443-2279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-747-2655
Provider Business Mailing Address Fax Number:
708-747-2859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2431 BETHANY RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60178-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-917-2871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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