Provider Demographics
NPI:1568094290
Name:WESTERMAN, MOLLY E (LICSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:WESTERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-0128
Mailing Address - Country:US
Mailing Address - Phone:320-200-0552
Mailing Address - Fax:320-287-7001
Practice Address - Street 1:221 STUDDART AVE
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-0128
Practice Address - Country:US
Practice Address - Phone:320-200-0552
Practice Address - Fax:320-287-7001
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN230211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical