Provider Demographics
NPI:1467212191
Name:JENNINGS, MOLLIE (SLPA)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5817
Mailing Address - Country:US
Mailing Address - Phone:573-803-3338
Mailing Address - Fax:
Practice Address - Street 1:2137 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5817
Practice Address - Country:US
Practice Address - Phone:573-803-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant