Provider Demographics
NPI:1124797428
Name:WHIPPLE, MOLLY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 NW 61ST ST APT G1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2985
Mailing Address - Country:US
Mailing Address - Phone:206-617-9067
Mailing Address - Fax:
Practice Address - Street 1:19324 40TH AVE W STE A
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5662
Practice Address - Country:US
Practice Address - Phone:425-658-2400
Practice Address - Fax:425-526-5550
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61210898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist