Provider Demographics
NPI:1528211091
Name:DUCKETT, MOLLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DUCKETT
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 1:155 COUNTRY ESTATES CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4035
Mailing Address - Country:US
Mailing Address - Phone:775-852-6323
Mailing Address - Fax:775-852-6321
Practice Address - Street 1:155 COUNTRY ESTATES CIR STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4035
Practice Address - Country:US
Practice Address - Phone:775-852-6323
Practice Address - Fax:775-852-6321
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist