Provider Demographics
NPI:1104680511
Name:CANDELARIA, MOLLY H (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:H
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 BOLLINGER RD
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1125
Mailing Address - Country:US
Mailing Address - Phone:484-881-1880
Mailing Address - Fax:
Practice Address - Street 1:151 BOLLINGER RD
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-1125
Practice Address - Country:US
Practice Address - Phone:484-881-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist