Provider Demographics
NPI:1578949251
Name:SOLL, SAMANTHA OLIVIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:OLIVIA
Last Name:SOLL
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 1:5344 N PAULINA ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2035
Mailing Address - Country:US
Mailing Address - Phone:319-541-7420
Mailing Address - Fax:
Practice Address - Street 1:5344 N PAULINA ST APT 3F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2035
Practice Address - Country:US
Practice Address - Phone:319-541-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009826101Y00000X
IL071010047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor