Provider Demographics
NPI:1073354361
Name:NOON, MOLLY REBECCA (BCBA, LBA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:REBECCA
Last Name:NOON
Suffix:
Gender:F
Credentials:BCBA, LBA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 N ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2810
Mailing Address - Country:US
Mailing Address - Phone:316-207-2596
Mailing Address - Fax:
Practice Address - Street 1:2319 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2810
Practice Address - Country:US
Practice Address - Phone:316-207-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2343235Z00000X
KS00707103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist