Provider Demographics
NPI:1194989020
Name:PURDY, MOLLANA CARSON (AUD)
Entity type:Individual
Prefix:
First Name:MOLLANA
Middle Name:CARSON
Last Name:PURDY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:DAWN
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:3366 OAKDALE AVE N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2948
Mailing Address - Country:US
Mailing Address - Phone:763-233-5755
Mailing Address - Fax:763-233-5782
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:SUITE 150
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-233-5755
Practice Address - Fax:763-233-5782
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2915231H00000X
MN8346231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist