Provider Demographics
NPI:1215206651
Name:FRENIA, MOLLY ANN (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ANN
Last Name:FRENIA
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOLLY
Mailing Address - Street 1:36 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2430
Mailing Address - Country:US
Mailing Address - Phone:585-254-3836
Mailing Address - Fax:
Practice Address - Street 1:36 OTIS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2430
Practice Address - Country:US
Practice Address - Phone:585-254-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist