Healthcare Provider Details

I. General information

NPI: 1487086336
Provider Name (Legal Business Name): MOLLY CHRISTINE STEPANIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W 106TH ST
BLOOMINGTON MN
55431-4126
US

IV. Provider business mailing address

2021 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3391
US

V. Phone/Fax

Practice location:
  • Phone: 952-806-8932
  • Fax:
Mailing address:
  • Phone: 925-945-1474
  • Fax: 925-945-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23091
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146012338
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number528949
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: