Provider Demographics
NPI:1922260967
Name:ROSTECK, MOLLY ANNE (MA, CFY/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANNE
Last Name:ROSTECK
Suffix:
Gender:F
Credentials:MA, CFY/SLP
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:ANNE
Other - Last Name:DUGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 SWAN LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9708
Mailing Address - Country:US
Mailing Address - Phone:319-334-5155
Mailing Address - Fax:
Practice Address - Street 1:2300 SWAN LAKE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9708
Practice Address - Country:US
Practice Address - Phone:319-334-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist