Provider Demographics
NPI:1811654734
Name:SOLOMON, ZOE LOUISE
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:LOUISE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:LOUISE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 W PIONEER PKWY STE 20
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-5805
Mailing Address - Country:US
Mailing Address - Phone:309-750-0119
Mailing Address - Fax:
Practice Address - Street 1:2000 W PIONEER PKWY STE 20
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-5805
Practice Address - Country:US
Practice Address - Phone:309-750-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist