Provider Demographics
NPI:1184823023
Name:FENWICK, MOLLY M (AUD)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:M
Last Name:FENWICK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 UNION AVENUE EXT STE 801
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4416
Mailing Address - Country:US
Mailing Address - Phone:901-726-0044
Mailing Address - Fax:901-726-0858
Practice Address - Street 1:540 W 5TH ST STE 410
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5067
Practice Address - Country:US
Practice Address - Phone:432-640-6360
Practice Address - Fax:432-640-4759
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1409231H00000X
TX81226231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist