Provider Demographics
NPI:1376216895
Name:BARRY, MOLLY JEAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:JEAN
Last Name:BARRY
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 1:1140 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6413
Mailing Address - Country:US
Mailing Address - Phone:541-543-9417
Mailing Address - Fax:
Practice Address - Street 1:1140 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6413
Practice Address - Country:US
Practice Address - Phone:541-543-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12047183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist