Provider Demographics
NPI:1346780087
Name:SMITH, MOLLIE JORDAN (BS, MS)
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:JORDAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W ALLENTON RD APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-6522
Mailing Address - Country:US
Mailing Address - Phone:401-263-3303
Mailing Address - Fax:
Practice Address - Street 1:345 W ALLENTON RD APT 1
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6522
Practice Address - Country:US
Practice Address - Phone:401-263-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist