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NPI Code Detail

MEDICARE: MOLLY KATHLEEN MINTO MA, CCC-SLP

MEDICARE: MOLLY KATHLEEN MINTO MA, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP21029CA

General Provider Information

NPI Number : 1609432269
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY KATHLEEN MINTO MA, CCC-SLP
Provider Business Mailing Address
First Line : 4890 DAWSON RD
Second Line :
City : CORNING
State : CA
Zip : 96021-9030
Country : US
Telephone Number : 530-864-9361
Fax Number :
Provider Business Practice Location Address
First Line : 1460 ELK CREEK DR
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-8237
Country : US
Telephone Number : 208-535-1286
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2019
Last Update Date : 05/19/2019

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