Provider Demographics
NPI:1104215466
Name:O'SULLIVAN, MOLLY (SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:O'SULLIVAN
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 1:47 MARY FRAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6312
Mailing Address - Country:US
Mailing Address - Phone:973-294-9597
Mailing Address - Fax:
Practice Address - Street 1:47 MARY FRAN DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-6312
Practice Address - Country:US
Practice Address - Phone:973-294-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist