Provider Demographics
NPI:1861692550
Name:MCNEILL, MOLLY MARIE (MCD, SLP-CF)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:MCD, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STONECREST BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6825
Mailing Address - Country:US
Mailing Address - Phone:615-220-5796
Mailing Address - Fax:615-220-8829
Practice Address - Street 1:300 STONECREST BLVD STE 375
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6825
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:615-220-8829
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709OtherSPEECH LANGUAGE PATHOLOGI