Provider Demographics
NPI:1215383849
Name:SOLOMON, DAWN (CACII)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 COUNTY ROAD 500
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8721
Mailing Address - Country:US
Mailing Address - Phone:970-749-6126
Mailing Address - Fax:970-884-2327
Practice Address - Street 1:254 COUNTY ROAD 500
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-8721
Practice Address - Country:US
Practice Address - Phone:970-749-6126
Practice Address - Fax:970-884-2327
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1814-00324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO471500723Medicaid