MEDICARE: KAREN KELLY MOLLISON MS CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0584	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518015189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KELLY MOLLISON MS CCC SLP

Provider Business Mailing Address
First Line	:	4602 E SUNSET DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6115
Country	:	US
Telephone Number	:	602-527-4829
Fax Number	:	480-483-1026

Provider Business Practice Location Address
First Line	:	5040 E SHEA BLVD STE 168
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4686
Country	:	US
Telephone Number	:	480-483-1025
Fax Number	:	480-483-1026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/09/2007

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