Doctor Name: | MOLLY BRYN STUCKEY |
NPI Number: | 1518220177 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 14040 |
Business Practice Address: | 1929 Main St Ste 103 Irvine, CA - 926146524 |
Business Phone Number: | 9495006318 |
Business Fax Number: | 9497979234 |
Mailing Address: | 1929 Main St Ste 103, IRVINE |
State: | CA |
Postal Code: | 926146524 |
Phone Number: | 9495006318 |
Fax Number: | 9497979234 |
NPI Enumeration Date: | 06/19/2012 |
NPI Last Update Date: | 06/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 14040 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |