Provider Demographics
NPI:1952671877
Name:SOLOMON, JOHN THOMAS (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1336
Mailing Address - Country:US
Mailing Address - Phone:203-230-9622
Mailing Address - Fax:
Practice Address - Street 1:103 THORNTON ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1336
Practice Address - Country:US
Practice Address - Phone:203-230-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12060644OtherASHA