Healthcare Provider Details

I. General information

NPI: 1720151376
Provider Name (Legal Business Name): MOLLY COLLEEN GREGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY COLLEEN GREGAN

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 S HARDY DR STE 110B
TEMPE AZ
85284-2008
US

IV. Provider business mailing address

14807 N 73RD ST STE 103
SCOTTSDALE AZ
85260-3106
US

V. Phone/Fax

Practice location:
  • Phone: 602-321-0802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5363
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License NumberSLPL4846
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: