Provider Demographics
NPI:1184876468
Name:MCDERMOTT, MOLLY CATHERINE (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:CATHERINE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-9373
Mailing Address - Country:US
Mailing Address - Phone:937-725-4949
Mailing Address - Fax:937-725-4949
Practice Address - Street 1:3318 WILSON RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9373
Practice Address - Country:US
Practice Address - Phone:937-725-4949
Practice Address - Fax:937-725-4949
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE5459235Z00000X
FLSA11915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist