Provider Demographics
NPI:1760135248
Name:POLASKY, MOLLY J
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:POLASKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 THUMBELINA LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4931
Mailing Address - Country:US
Mailing Address - Phone:513-470-5291
Mailing Address - Fax:513-793-8237
Practice Address - Street 1:7210 THUMBELINA LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4931
Practice Address - Country:US
Practice Address - Phone:513-470-5291
Practice Address - Fax:513-793-8237
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist