Provider Demographics
NPI:1477058246
Name:HAMILTON, MOLLY MARIE
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S MCKINLEY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1800
Mailing Address - Country:US
Mailing Address - Phone:636-583-5801
Mailing Address - Fax:636-583-5597
Practice Address - Street 1:1312 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1208
Practice Address - Country:US
Practice Address - Phone:636-583-5801
Practice Address - Fax:636-583-5597
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018006443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist