Provider Demographics
NPI:1730327289
Name:GOLLIS, CHRISTINA ROSE (MS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ROSE
Last Name:GOLLIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:ROSE
Other - Last Name:MOLLOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1966 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7205
Mailing Address - Country:US
Mailing Address - Phone:972-883-3010
Mailing Address - Fax:972-883-3022
Practice Address - Street 1:2895 FACILITIES WAY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-0034
Practice Address - Country:US
Practice Address - Phone:972-883-3660
Practice Address - Fax:972-553-3622
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist