Provider Demographics
NPI:1285271742
Name:RUSCHAU, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:RUSCHAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 US HIGHWAY 46 STE G51
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1676
Mailing Address - Country:US
Mailing Address - Phone:973-588-7266
Mailing Address - Fax:973-588-7268
Practice Address - Street 1:21245 LORAIN RD STE 202
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2140
Practice Address - Country:US
Practice Address - Phone:440-333-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03147237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter