Provider Demographics
NPI:1346901170
Name:BILICH, MOLLY ROSE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ROSE
Last Name:BILICH
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 1:11A55 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:APPLE RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:61001-9760
Mailing Address - Country:US
Mailing Address - Phone:815-601-4815
Mailing Address - Fax:
Practice Address - Street 1:421 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4008
Practice Address - Country:US
Practice Address - Phone:815-599-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program