Provider Demographics
NPI:1245776046
Name:SOLIS, TREVOR PATRICK (CFY-SLP)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:PATRICK
Last Name:SOLIS
Suffix:
Gender:M
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GENESEE
Mailing Address - State:PA
Mailing Address - Zip Code:16923-8764
Mailing Address - Country:US
Mailing Address - Phone:814-228-3530
Mailing Address - Fax:
Practice Address - Street 1:800 N MEDCALF LN
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-1318
Practice Address - Country:US
Practice Address - Phone:360-249-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60722911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist