Provider Demographics
NPI:1336374230
Name:GILBERT, MOLLY P (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:P
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:P
Other - Last Name:KEEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:15416 27TH CT E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-1841
Mailing Address - Country:US
Mailing Address - Phone:260-249-5797
Mailing Address - Fax:
Practice Address - Street 1:15416 27TH CT E
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219
Practice Address - Country:US
Practice Address - Phone:260-249-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12127775235Z00000X
FL22004505A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist