Provider Demographics
NPI:1194537563
Name:BARBER, MOLLY MAKELA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MAKELA
Last Name:BARBER
Suffix:
Gender:F
Credentials: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:PO BOX 4180
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4180
Mailing Address - Country:US
Mailing Address - Phone:307-733-3791
Mailing Address - Fax:
Practice Address - Street 1:3105 W BIG TRAIL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9296
Practice Address - Country:US
Practice Address - Phone:307-733-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-1151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist