Provider Demographics
NPI:1336641869
Name:MARTIN, MOLLY (LISW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BOYSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1270
Mailing Address - Country:US
Mailing Address - Phone:319-693-5694
Mailing Address - Fax:
Practice Address - Street 1:1811 BOYSON RD STE A
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1270
Practice Address - Country:US
Practice Address - Phone:319-693-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical