Healthcare Provider Details

I. General information

NPI: 1467212191
Provider Name (Legal Business Name): MOLLIE JENNINGS MA-CF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 WILLIAM ST
CAPE GIRARDEAU MO
63703-5817
US

IV. Provider business mailing address

2137 WILLIAM ST
CAPE GIRARDEAU MO
63703-5817
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-3338
  • Fax:
Mailing address:
  • Phone: 573-803-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026038842
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: