Healthcare Provider Details

I. General information

NPI: 1053226761
Provider Name (Legal Business Name): MOLLY SHERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 ELK CREEK DR
IDAHO FALLS ID
83404-8237
US

IV. Provider business mailing address

685 FORT FILLMORE RD
MESILLA PARK NM
88047-9709
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-1286
  • Fax:
Mailing address:
  • Phone: 575-644-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: