Provider Demographics
NPI:1285003244
Name:WALZ, MOLLY ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:WALZ
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 1:21374 E AUBLE RD
Mailing Address - Street 2:
Mailing Address - City:STAPLETON
Mailing Address - State:NE
Mailing Address - Zip Code:69163-9128
Mailing Address - Country:US
Mailing Address - Phone:308-530-9792
Mailing Address - Fax:
Practice Address - Street 1:1221 W 17TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-2216
Practice Address - Country:US
Practice Address - Phone:308-534-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist