Individual
MARY KATHERINE MOLLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-2134
Mailing address
23805 RAVINEVIEW CT, BINGHAM FARMS, MI 48025-4650
(248) 568-0772
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101001214
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7101001214
BOARD OF SPEECH-LANGUAGE PATHOLOGY: SPEECH-LANGUAGE PATHOLOGIST LICENSE
MI
Enumeration date
12/18/2019
Last updated
12/18/2019
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