Provider Demographics
NPI:1891033072
Name:HANFORD, MOLLY GEORGIANNE (MS TSSLD)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:GEORGIANNE
Last Name:HANFORD
Suffix:
Gender:F
Credentials:MS TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-0041
Mailing Address - Country:US
Mailing Address - Phone:315-788-2730
Mailing Address - Fax:315-788-8557
Practice Address - Street 1:200 CENTER AVE.
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035
Practice Address - Country:US
Practice Address - Phone:505-832-4471
Practice Address - Fax:505-832-4472
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5333235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist