Provider Demographics
NPI:1750305694
Name:SOLOLDKY, MAURICE L (PHD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:L
Last Name:SOLOLDKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1604
Mailing Address - Country:US
Mailing Address - Phone:708-848-8770
Mailing Address - Fax:708-660-9841
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:312-301-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist