Individual
MOLLY BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
311 COOPER RD, LOGANVILLE, GA 30052-4976
(678) 205-5437
Mailing address
311 COOPER RD, LOGANVILLE, GA 30052-4976
(678) 205-5437
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005359
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009945728A
—
GA
Enumeration date
10/31/2006
Last updated
09/22/2008
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