Provider Demographics
NPI:1174192363
Name:MARRA, MOLLY (PHD, MS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MARRA
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SW CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3130
Mailing Address - Country:US
Mailing Address - Phone:503-494-7338
Mailing Address - Fax:
Practice Address - Street 1:545 SW CAMPUS DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3130
Practice Address - Country:US
Practice Address - Phone:503-494-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS