Individual
JENNIFER L MOLLERUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3321 GEORGIA ST, LOUISIANA, MO 63353-2751
(573) 754-6181
Mailing address
3321 GEORGIA ST, LOUISIANA, MO 63353-2751
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2017026187
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750895108
—
MO
Enumeration date
11/21/2017
Last updated
11/22/2021
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