Provider Demographics
NPI:1659099141
Name:SOLIS, MOLLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MISTY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2703
Mailing Address - Country:US
Mailing Address - Phone:817-408-4000
Mailing Address - Fax:
Practice Address - Street 1:1500 MISTY MEADOW DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2703
Practice Address - Country:US
Practice Address - Phone:817-408-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28304721OtherDRIVER'S LICENSE NUMBER