Provider Demographics
NPI:1164835484
Name:ELLIOTT, MOLLIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 ASH GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5383
Mailing Address - Country:US
Mailing Address - Phone:505-610-1620
Mailing Address - Fax:
Practice Address - Street 1:17480 DALLAS PKWY STE 221
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7361
Practice Address - Country:US
Practice Address - Phone:214-623-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist