Provider Demographics
NPI:1780758805
Name:SOLOMON, ANITA M (MS, CCC-A, F-AAA)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:MS, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 LINCOLN ST
Mailing Address - Street 2:STE 105
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-755-1391
Mailing Address - Fax:508-363-4019
Practice Address - Street 1:295 LINCOLN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3639
Practice Address - Country:US
Practice Address - Phone:508-755-1391
Practice Address - Fax:508-363-4019
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA762231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
26550OtherFALLON
5104033OtherMASS HEALTH
AD0187OtherAETNA
MASO 039764OtherMEDICARE ID
AD0187OtherBCBS
MA5104033Medicaid