Provider Demographics
NPI:1992239651
Name:SILLICH, MOLLY M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:SILLICH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:92 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-4013
Mailing Address - Country:US
Mailing Address - Phone:603-533-0299
Mailing Address - Fax:
Practice Address - Street 1:92 TOWN FARM RD
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:NH
Practice Address - Zip Code:03070-4013
Practice Address - Country:US
Practice Address - Phone:603-533-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist