Provider Demographics
NPI:1245796051
Name:BRANDENBURG, MOLLY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 SANTA FE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3655
Mailing Address - Country:US
Mailing Address - Phone:913-286-0422
Mailing Address - Fax:844-380-0832
Practice Address - Street 1:13418 SANTA FE TRAIL DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3655
Practice Address - Country:US
Practice Address - Phone:913-286-0422
Practice Address - Fax:844-380-0832
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist