Provider Demographics
NPI:1558448134
Name:SOLON, PHYLLIS C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:C
Last Name:SOLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 26TH ST
Mailing Address - Street 2:302C
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4359
Mailing Address - Country:US
Mailing Address - Phone:612-309-7902
Mailing Address - Fax:612-870-8944
Practice Address - Street 1:118 E 26TH ST
Practice Address - Street 2:302C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4359
Practice Address - Country:US
Practice Address - Phone:612-309-7902
Practice Address - Fax:612-870-8944
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN733825200OtherMEDICAL ASSISTANCE