Provider Demographics
NPI:1598862633
Name:SOLLIDAY, CYNTHIA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:SOLLIDAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12802 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-1606
Mailing Address - Country:US
Mailing Address - Phone:262-327-6381
Mailing Address - Fax:262-794-3146
Practice Address - Street 1:12802 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1606
Practice Address - Country:US
Practice Address - Phone:262-327-6381
Practice Address - Fax:262-794-3146
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2410-057103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39141100Medicaid
WI0005-00113Medicare ID - Type UnspecifiedELMBROOK MEDI SEQUENCE #
WI39141100Medicaid