Provider Demographics
NPI:1942544366
Name:DAVIS, MOLLY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6590 TRYON RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7052
Mailing Address - Country:US
Mailing Address - Phone:919-851-8000
Mailing Address - Fax:
Practice Address - Street 1:6590 TRYON RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7052
Practice Address - Country:US
Practice Address - Phone:919-851-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist