Provider Demographics
NPI:1548512072
Name:DONOVAN, MOLLI (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLI
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MOLLI
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8444 MOREHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5833
Mailing Address - Country:US
Mailing Address - Phone:740-352-6557
Mailing Address - Fax:740-352-6557
Practice Address - Street 1:8444 MOREHOUSE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5833
Practice Address - Country:US
Practice Address - Phone:740-352-6557
Practice Address - Fax:740-352-6557
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLS7 5911235Z00000X
FLSA13005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist