Individual
MOLLY A GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3360 GATEWAY RD STE 100, BROOKFIELD, WI 53045-5115
(262) 923-7101
Mailing address
165 FOX FIRE DR, OSHKOSH, WI 54904-6558
(920) 426-8463
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1408
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42754200
—
WI
Enumeration date
01/29/2007
Last updated
04/30/2024
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