Provider Demographics
NPI:1871117978
Name:MOLINA, JACQUELINE ROCIO (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ROCIO
Last Name:MOLINA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 FULTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3479
Mailing Address - Country:US
Mailing Address - Phone:415-672-0643
Mailing Address - Fax:
Practice Address - Street 1:2121 PINE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2829
Practice Address - Country:US
Practice Address - Phone:415-922-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist