Provider Demographics
NPI:1598066177
Name:MUELLER, MOLLY MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MARIE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-9511
Mailing Address - Country:US
Mailing Address - Phone:636-668-8188
Mailing Address - Fax:636-668-8641
Practice Address - Street 1:701 ELM STREET
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389-9511
Practice Address - Country:US
Practice Address - Phone:636-668-8188
Practice Address - Fax:636-668-8641
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist