Provider Demographics
NPI:1144620295
Name:RODDEN, MOLLY (MSN NP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:RODDEN
Suffix:
Gender:F
Credentials:MSN NP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14845 SW MURRAY SCHOLLS DR.
Mailing Address - Street 2:STE. 110 PMB 412
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0412
Mailing Address - Country:US
Mailing Address - Phone:360-836-0171
Mailing Address - Fax:618-882-4174
Practice Address - Street 1:14845 SW MURRAY SCHOLLS DR STE 110
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9237
Practice Address - Country:US
Practice Address - Phone:360-836-0171
Practice Address - Fax:618-882-4174
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201705273NP-PP363LF0000X, 363LP0808X
IL209011748363LF0000X
OR201902719NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500730619Medicaid