MEDICARE: MRS. MOLLY SIMON

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		FL

General Provider Information

NPI Number	:	1770590549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLY SIMON

Provider Business Mailing Address
First Line	:	9525 CROSS CREEK DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-2928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 CROSS CREEK DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-2928
Country	:	US
Telephone Number	:	561-391-8444
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. MOLLY SIMON ” Practice Location

Language	Start Address	Practice Location

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