Provider Demographics
NPI:1760548218
Name:CHAPMAN, SAUL HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAUL
Middle Name:HOWARD
Last Name:CHAPMAN
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 1:1008 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1154
Mailing Address - Country:US
Mailing Address - Phone:618-549-5043
Mailing Address - Fax:
Practice Address - Street 1:3200 FISHBACK ROAD
Practice Address - Street 2:MILWOOD EXECUTIVE SUITES
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-6307
Practice Address - Country:US
Practice Address - Phone:618-549-5043
Practice Address - Fax:618-351-1419
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0152091103G00000X, 103T00000X
IL07006462103T00000X
IL103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3932031OtherBCBSIL
IL3932031OtherBCBSIL