Healthcare Provider Details

I. General information

NPI: 1528471067
Provider Name (Legal Business Name): MOLLY VACCARO MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16501 NORTHCROSS DR STE D
HUNTERSVILLE NC
28078-5040
US

IV. Provider business mailing address

129 SWAMP ROSE DR
MOORESVILLE NC
28117-7587
US

V. Phone/Fax

Practice location:
  • Phone: 704-800-5232
  • Fax: 704-765-4822
Mailing address:
  • Phone: 540-290-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: