Provider Demographics
NPI:1073018644
Name:PRATT, MOLLY LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LYNN
Last Name:PRATT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 OLD COLONY WAY UNIT A6
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-9232
Mailing Address - Country:US
Mailing Address - Phone:802-681-6729
Mailing Address - Fax:
Practice Address - Street 1:73 OLD COLONY WAY UNIT A6
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:VT
Practice Address - Zip Code:05763-9232
Practice Address - Country:US
Practice Address - Phone:802-681-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0114702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist