NPI 1457685414 SCHOCK MOLLY Z. M.A._ CCC-SLP - HIPAASpace

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NPI 1457685414 SCHOCK MOLLY Z. M.A._ CCC-SLP - HIPAASpace Powered By Docstoc
					                                                                                                                                                   HIPAASpace NPI Form
WWW.HIPAASPACE.COM                                                                                                                                    Source NPI Lookup


                              NATIONAL PROVIDER IDENTIFIER (NPI) FORM
Information provided in the current document is obtained from official source and accuracy of the information provided is the sole
responsibility of the healthcare provide. All changes, corrections or updates must be done through the official sources. Please contact
HIPAASpace.com in case you need the assistance in obtaining the official contacts of corresponding government organizations.

SECTION 1 – BASIC INFORMATION
 NPI Number          Provider (Organization) Full Name                  Provider (Organization) Other Name                         Entity Type          Replacement NPI

 1457685414            MOLLY Z. M.A., CCC-SLP                                                                                      Individual
 Gender        Enumeration Date     Last Update Date     Deactivation Reason Code      Deactivation Date       Reactivation Date    Employer Identification Number (EIN)

 Female        09/23/2009           09/23/2009

SECTION 2 – CONTACT INFORMATION
 Business Mailing Address

 8901 GRANT ST APT. 1936, THORNTON CO80229-4421 US
 Practice Location Address

 8901 GRANT ST APT. 1936, THORNTON CO80229-4421 US
 Business Phone Number                       Business Fax Number                            Practice Phone Number                            Practice Fax Number

                                                                                            937-765-1045
 Authorized Official – Name                                                         Authorized Official – Title/Position              Authorized Official - Phone Number




SECTION 3 – LICENSING, IDENTIFICATION INFORMATION

A. TAXONOMY INFORMATION

1. Code: 235Z00000X (Speech-Language Pathologist).




B. OTHER PROVIDER IDENTIFIERS




www.hipaaspace.com                                                                        NPI Profile: 1457685414                  MOLLY Z. M.A., CCC-SLP

				
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