Provider Demographics
NPI:1598279630
Name:KASPERSKI, MOLLY KATHLEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:KASPERSKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:1009 BOYCE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2500
Mailing Address - Country:US
Mailing Address - Phone:815-433-6433
Mailing Address - Fax:815-433-6164
Practice Address - Street 1:1009 BOYCE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2500
Practice Address - Country:US
Practice Address - Phone:815-433-6433
Practice Address - Fax:815-433-6164
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL146007799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist