Provider Demographics
NPI:1508030800
Name:MOLINA-WHILLOCK, MARIA MERCEDES (MSSLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MERCEDES
Last Name:MOLINA-WHILLOCK
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16830 W LAMBERT LN
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-9271
Mailing Address - Country:US
Mailing Address - Phone:520-682-6330
Mailing Address - Fax:520-682-3006
Practice Address - Street 1:16830 W LAMBERT LN
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9271
Practice Address - Country:US
Practice Address - Phone:520-682-6330
Practice Address - Fax:520-682-3006
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist