Provider Demographics
NPI:1982100871
Name:CLAY, MOLLY QUIN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:QUIN
Last Name:CLAY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HIGHWAY 51 STE H
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8437
Mailing Address - Country:US
Mailing Address - Phone:601-853-4040
Mailing Address - Fax:
Practice Address - Street 1:745 HIGHWAY 51 STE H
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8437
Practice Address - Country:US
Practice Address - Phone:601-853-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist