Provider Demographics
NPI:1659883809
Name:SOLIS, LILIANA MAYELA (BS, ASSISTANT SLP)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:MAYELA
Last Name:SOLIS
Suffix:
Gender:F
Credentials:BS, ASSISTANT SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-3740
Mailing Address - Country:US
Mailing Address - Phone:817-658-5679
Mailing Address - Fax:
Practice Address - Street 1:1200 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4403
Practice Address - Country:US
Practice Address - Phone:817-546-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376202355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant