Provider Demographics
NPI:1396958104
Name:DEWEESE, MOLLY CLUNE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:CLUNE
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 CHIMNEY TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9611
Mailing Address - Country:US
Mailing Address - Phone:585-872-4698
Mailing Address - Fax:
Practice Address - Street 1:1000 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3042
Practice Address - Country:US
Practice Address - Phone:585-271-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist