Provider Demographics
NPI:1811470370
Name:SOLOWAY, MATTHEW JEFFREY (BCBA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JEFFREY
Last Name:SOLOWAY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2009 GREYSTEM CIR APT 308
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9329
Mailing Address - Country:US
Mailing Address - Phone:904-868-5135
Mailing Address - Fax:
Practice Address - Street 1:9309 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1139
Practice Address - Country:US
Practice Address - Phone:847-651-9907
Practice Address - Fax:847-324-2184
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-21-52038103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst