Basic Information
| Provider Information | |||||||||
| NPI: | 1457367476 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOLOMON | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 CLAY CT | ||||||||
| Address2: | |||||||||
| City: | WEST LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479061164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654943820 | ||||||||
| FaxNumber: | 7654940771 | ||||||||
| Practice Location | |||||||||
| Address1: | 1353 HEAVILON HALL | ||||||||
| Address2: | 500 OVAL DRIVE | ||||||||
| City: | WEST LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479072038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654943820 | ||||||||
| FaxNumber: | 7654940771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22001072A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 000000582177 | 01 | IN | ANTHEM | OTHER | 200903200 | 05 | IN | MEDICAID |