Provider Demographics
NPI:1487931010
Name:MOLLOY, ANDREA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MOLLOY
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 1:7253 OWASCO RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5132
Mailing Address - Country:US
Mailing Address - Phone:315-253-6283
Mailing Address - Fax:315-282-0024
Practice Address - Street 1:7253 OWASCO RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-5132
Practice Address - Country:US
Practice Address - Phone:315-253-6283
Practice Address - Fax:315-282-0024
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020846-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist