Provider Demographics
NPI:1376999649
Name:MOLUS, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MOLUS
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 1:257 PARKLAND HTS
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-6017
Mailing Address - Country:US
Mailing Address - Phone:859-234-6940
Mailing Address - Fax:859-234-5772
Practice Address - Street 1:257 PARKLAND HTS
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-6017
Practice Address - Country:US
Practice Address - Phone:859-234-6940
Practice Address - Fax:859-234-5772
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid