MEDICARE: MOLLY DUCEY 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
1	235Z00000X	Speech-Language Pathologist	SLO005787	GA

General Provider Information

NPI Number	:	1700942588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY DUCEY CCC-SLP

Provider Business Mailing Address
First Line	:	6255 BARFIELD RD NE STE 165
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4333
Country	:	US
Telephone Number	:	404-250-0807
Fax Number	:

Provider Business Practice Location Address
First Line	:	6255 BARFIELD RD NE STE 165
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4333
Country	:	US
Telephone Number	:	404-250-0807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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Directions to “ MOLLY DUCEY CCC-SLP” Practice Location

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