MEDICARE: MOLLY E GENTRY M/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	6861	SC
2	235Z00000X	Speech-Language Pathologist	20200846	VA

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	:	1750746467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY E GENTRY M/SLP

Provider Business Mailing Address
First Line	:	1226 AMBLING WAY DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7524
Country	:	US
Telephone Number	:	443-604-7943
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 AMBLING WAY DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7524
Country	:	US
Telephone Number	:	443-604-7943
Fax Number	:

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

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	02/06/2025

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Directions to “ MOLLY E GENTRY M/SLP” Practice Location

Language	Start Address	Practice Location

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