Provider Demographics
NPI:1467884833
Name:EVERSON, MOLLY C (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:C
Last Name:EVERSON
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:PO BOX 2994
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2994
Mailing Address - Country:US
Mailing Address - Phone:509-888-3062
Mailing Address - Fax:509-888-3063
Practice Address - Street 1:528 E SPOKANE FALLS BLVD
Practice Address - Street 2:STE 401
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5050
Practice Address - Country:US
Practice Address - Phone:509-435-0481
Practice Address - Fax:509-435-0485
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60389626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121189Medicaid