Provider Demographics
NPI:1669827333
Name:WARNER, MOLLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:WARNER
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 1:13336 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-330-3211
Mailing Address - Fax:402-330-5970
Practice Address - Street 1:831 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4723
Practice Address - Country:US
Practice Address - Phone:641-417-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE495235Z00000X
NE1931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477700Medicaid