Healthcare Provider Details

I. General information

NPI: 1346499274
Provider Name (Legal Business Name): MONICA ANN SOLIS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 CORRALITOS RD
ROSWELL NM
88201-9163
US

IV. Provider business mailing address

1008 CORRALITOS RD
ROSWELL NM
88201-9163
US

V. Phone/Fax

Practice location:
  • Phone: 575-420-8772
  • Fax: 575-748-6160
Mailing address:
  • Phone: 575-420-8772
  • Fax: 575-748-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberC-4423
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4619
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: