1306298666 NPI number — MRS. MOLLY PATRICIA CANTARELLA SLP

Table of content: MRS. MOLLY PATRICIA CANTARELLA SLP (NPI 1306298666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306298666 NPI number — MRS. MOLLY PATRICIA CANTARELLA SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTARELLA
Provider First Name:
MOLLY
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMULLEN
Provider Other First Name:
MOLLY
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306298666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 MULBERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-646-9574
Provider Business Mailing Address Fax Number:
325-646-7590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 MULBERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-646-9574
Provider Business Practice Location Address Fax Number:
325-646-7590
Provider Enumeration Date:
07/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  112384 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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