Healthcare Provider Details

I. General information

NPI: 1669700662
Provider Name (Legal Business Name): SOL CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S. 3RD AVE.
PASCO WA
99301
US

IV. Provider business mailing address

P.O. BOX 690
PASCO WA
99301
US

V. Phone/Fax

Practice location:
  • Phone: 509-542-8890
  • Fax: 866-204-7309
Mailing address:
  • Phone: 509-542-8890
  • Fax: 866-204-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00003590
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY00003590
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. ROLANDO RODRIGUEZ
Title or Position: MANAGER
Credential: C.D.M.S.
Phone: 509-542-8890