MEDICARE: MOLLIE GWINN M.S., 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	1709	NH

General Provider Information

NPI Number	:	1831637941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE GWINN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	78 MONROE ST
Second Line	:
City	:	AMESBURY
State	:	MA
Zip	:	01913-3215
Country	:	US
Telephone Number	:	978-270-6020
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 MONROE ST
Second Line	:
City	:	AMESBURY
State	:	MA
Zip	:	01913-3215
Country	:	US
Telephone Number	:	978-270-6020
Fax Number	:

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	01/05/2024

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