Provider Demographics
NPI:1316214653
Name:LEPAK, MOLLY SUZANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:SUZANNE
Last Name:LEPAK
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 1:2220 OXFORD CT APT 8
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-4156
Mailing Address - Country:US
Mailing Address - Phone:715-570-5534
Mailing Address - Fax:
Practice Address - Street 1:1821 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-1910
Practice Address - Country:US
Practice Address - Phone:715-675-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3379-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist