Provider Demographics
NPI:1962722363
Name:HUNTER, MOLLY R (AUD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:R
Last Name:HUNTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:R
Other - Last Name:BERGSBAKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:11080 HALL RD STE A
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11080 HALL RD STE A
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1511
Practice Address - Country:US
Practice Address - Phone:586-254-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000635231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F399670OtherBCBSM GROUP PIN
MI700F399670OtherBCBSM GROUP PIN