| Doctor Name: | NICOLE MOLUMBY |
| NPI Number: | 1053787317 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 4519 |
| Business Practice Address: | 4629 S Harvard Ave Suite A Tulsa, OK - 741352948 |
| Business Phone Number: | 9187102370 |
| Business Fax Number: | 9183987983 |
| Mailing Address: | 5711 N 34th St, BROKEN ARROW |
| State: | OK |
| Postal Code: | 740141753 |
| Phone Number: | 8163902110 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2015 |
| NPI Last Update Date: | 05/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 4519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |