Provider Demographics
NPI:1225518814
Name:MOLER, SULEKHA MAYRUTH MAXFIELD (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SULEKHA
Middle Name:MAYRUTH MAXFIELD
Last Name:MOLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SULEKHA
Other - Middle Name:MAYRUTH
Other - Last Name:MAXFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2806 REAL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1715
Mailing Address - Country:US
Mailing Address - Phone:512-474-1411
Mailing Address - Fax:512-474-5401
Practice Address - Street 1:2806 REAL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1715
Practice Address - Country:US
Practice Address - Phone:512-474-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist