Provider Demographics
NPI:1194989020
Name:PURDY, MOLLANA CARSON (AUD)
Entity type:Individual
Prefix:
First Name:MOLLANA
Middle Name:CARSON
Last Name:PURDY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:DAWN
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:8301 GOLDEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4475
Mailing Address - Country:US
Mailing Address - Phone:763-233-5755
Mailing Address - Fax:763-233-5782
Practice Address - Street 1:9825 HOSPITAL DR STE 203
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4772
Practice Address - Country:US
Practice Address - Phone:763-233-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8346231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist