Provider Demographics
NPI:1063726180
Name:ROBERTS, MOLLY DART (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:DART
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 HAMMERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-1913
Mailing Address - Country:US
Mailing Address - Phone:713-467-4696
Mailing Address - Fax:
Practice Address - Street 1:11001 HAMMERLY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-1913
Practice Address - Country:US
Practice Address - Phone:713-467-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6311235Z00000X
TX106962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist