Provider Demographics
NPI:1891075008
Name:KEATING, MOLLY MARIE (SLP-CF)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:KEATING
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 CADENZA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-4923
Mailing Address - Country:US
Mailing Address - Phone:214-328-4309
Mailing Address - Fax:
Practice Address - Street 1:8550 CADENZA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-4923
Practice Address - Country:US
Practice Address - Phone:214-328-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist