Healthcare Provider Details

I. General information

NPI: 1578819843
Provider Name (Legal Business Name): MOLLY MARIE SLOAN M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 NE WOODS CHAPEL RD STE 255
LEES SUMMIT MO
64064-1989
US

IV. Provider business mailing address

10411 BOND ST
OVERLAND PARK KS
66214-2717
US

V. Phone/Fax

Practice location:
  • Phone: 913-209-9292
  • Fax:
Mailing address:
  • Phone: 913-209-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2623
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: