Healthcare Provider Details

I. General information

NPI: 1821845819
Provider Name (Legal Business Name): MOLLY JANE HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6617
US

IV. Provider business mailing address

65 N ALLEN AVE APT 306
PASADENA CA
91106-2230
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax:
Mailing address:
  • Phone: 720-233-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: