Healthcare Provider Details

I. General information

NPI: 1174435531
Provider Name (Legal Business Name): MOLLY MCCLURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 COOPER RD
VANDERBILT PA
15486-1319
US

IV. Provider business mailing address

163 COOPER RD
VANDERBILT PA
15486-1319
US

V. Phone/Fax

Practice location:
  • Phone: 724-880-8067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12097
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2026-0308
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL013598
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: