Provider Demographics
NPI:1881062388
Name:AXWORTHY, MOLLY
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:AXWORTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:1311 S UNION AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1959
Mailing Address - Country:US
Mailing Address - Phone:253-759-3555
Mailing Address - Fax:253-759-2988
Practice Address - Street 1:1311 S UNION AVE
Practice Address - Street 2:STE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1959
Practice Address - Country:US
Practice Address - Phone:253-759-3555
Practice Address - Fax:253-759-2988
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60528788237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist