Provider Demographics
NPI:1053055798
Name:WILKIE, MOLLY KATE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATE
Last Name:WILKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-3434
Mailing Address - Country:US
Mailing Address - Phone:518-761-6580
Mailing Address - Fax:
Practice Address - Street 1:1340 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3434
Practice Address - Country:US
Practice Address - Phone:518-761-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator