Provider Demographics
NPI:1548434350
Name:SHARP, MOLLY J (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:J
Last Name:SHARP
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8329
Mailing Address - Country:US
Mailing Address - Phone:262-697-0610
Mailing Address - Fax:
Practice Address - Street 1:6101 16TH ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4467
Practice Address - Country:US
Practice Address - Phone:262-637-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1879-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist