Provider Demographics
NPI:1497963672
Name:BOULWARE, MOLLY MAHONEY (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MAHONEY
Last Name:BOULWARE
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 BRIDE WATER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4300
Mailing Address - Country:US
Mailing Address - Phone:614-562-3190
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2262
Practice Address - Country:US
Practice Address - Phone:614-889-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist