Provider Demographics
NPI:1881208403
Name:MARTIN, MOLLY ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:MARTIN
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 1:6553 MAPLEWOOD RD APT 103
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1940
Mailing Address - Country:US
Mailing Address - Phone:440-429-2373
Mailing Address - Fax:
Practice Address - Street 1:3134 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9442
Practice Address - Country:US
Practice Address - Phone:440-563-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist