Provider Demographics
NPI:1033787171
Name:HARLAN, MOLLY (LMP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HARLAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 SE MILL PLAIN BLVD STE 2C
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5082
Mailing Address - Country:US
Mailing Address - Phone:360-253-6674
Mailing Address - Fax:
Practice Address - Street 1:11516 SE MILL PLAIN BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5082
Practice Address - Country:US
Practice Address - Phone:360-253-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60236112225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist