Molly Georgianne Hanford, MS TSSLD

Individual provider Active NPI Speech-Language Pathologist · Moriarty, NM

NPI 1891033072 · NPPES record last updated Sep 7, 2016

Key facts

NPI
1891033072
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
5333 (NM)
Practice address
200 Center Ave.
Moriarty, NM 87035
Phone
(505) 832-4471
Fax
(505) 832-4472
NPI assigned
Jan 23, 2013
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
5333NMMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Moriarty-Edgewood School District Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 5333 NM Yes

Addresses

Primary practice location

200 Center Ave.
Moriarty, NM 87035

Mailing address

PO Box 41
Watertown, NY 13601-0041
Phone (315) 788-2730

Other providers in Moriarty, NM

All providers in Moriarty, NM · Speech-Language Pathologist in New Mexico

Sources for this page

Verify at the official NPI Registry.