Provider Demographics
NPI:1245656016
Name:HALBACH, MOLLY REGAL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:REGAL
Last Name:HALBACH
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 1:3405 PEMBROOKE PKWY S
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4917
Mailing Address - Country:US
Mailing Address - Phone:214-240-5375
Mailing Address - Fax:
Practice Address - Street 1:201 FOCH STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:844-757-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist