Provider Demographics
NPI:1609206119
Name:NICOLAI, MOLLY O'DONNELL (SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:O'DONNELL
Last Name:NICOLAI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 TROY LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-1013
Mailing Address - Country:US
Mailing Address - Phone:952-797-4088
Mailing Address - Fax:
Practice Address - Street 1:6071 TROY LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-1013
Practice Address - Country:US
Practice Address - Phone:529-797-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist