Provider Demographics
NPI:1144110560
Name:SOLOMON, JACK LAMONT JR
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:LAMONT
Last Name:SOLOMON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17055 JODAVE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1409
Mailing Address - Country:US
Mailing Address - Phone:773-269-0691
Mailing Address - Fax:
Practice Address - Street 1:17055 JODAVE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1409
Practice Address - Country:US
Practice Address - Phone:773-269-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty