Provider Demographics
NPI:1336876424
Name:MATEJCIC, MOLLY (SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MATEJCIC
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 TIMBERLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4119
Mailing Address - Country:US
Mailing Address - Phone:405-496-5121
Mailing Address - Fax:
Practice Address - Street 1:400A HIGH SCHOOL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3635
Practice Address - Country:US
Practice Address - Phone:469-713-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist