Provider Demographics
NPI:1922600485
Name:DALLE MOLLE, MARIE ELISE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELISE
Last Name:DALLE MOLLE
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 1:6609 HANSA LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2206
Mailing Address - Country:US
Mailing Address - Phone:630-750-3699
Mailing Address - Fax:
Practice Address - Street 1:14058 BEE CAVE PKWY BLDG B
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7072
Practice Address - Country:US
Practice Address - Phone:512-872-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146.015698235Z00000X
TX117779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist