| Doctor Name: | MOLLY ANN ITA |
| NPI Number: | 1396960530 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 100173 |
| Business Practice Address: | 25252 Roselawn Rd Blanchard, OK - 730103701 |
| Business Phone Number: | 4054853347 |
| Business Fax Number: | |
| Mailing Address: | 25252 Roselawn Rd, BLANCHARD |
| State: | OK |
| Postal Code: | 730103701 |
| Phone Number: | 4054853347 |
| Fax Number: | |
| NPI Enumeration Date: | 04/14/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 100173 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| 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 |