Provider Demographics
NPI:1336692581
Name:SYLVESTER, MOLLIE BROWN (AU D)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:BROWN
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W PINHOOK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2464
Mailing Address - Country:US
Mailing Address - Phone:337-237-0650
Mailing Address - Fax:888-990-2781
Practice Address - Street 1:1000 W PINHOOK RD STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2464
Practice Address - Country:US
Practice Address - Phone:337-237-0650
Practice Address - Fax:888-990-2781
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-24
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1196A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL211100Medicaid