Individual
MARIAM MOLDENHAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
6035 PEACHTREE RD STE C1206035, DORAVILLE, GA 30360-3230
(770) 410-7719
(770) 410-9510
Mailing address
6035 PEACHTREE RD STE C120, DORAVILLE, GA 30360-3234
(678) 514-3270
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP010986
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003232001B
—
GA
05
—
003232001C
—
GA
Enumeration date
04/09/2020
Last updated
02/09/2023
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