Provider Demographics
NPI:1568592053
Name:KODL, MOLLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:KODL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MIDDLECAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:PTSR 116 A6
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-2125
Mailing Address - Fax:612-467-5971
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:PTSR 116 A6
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-2125
Practice Address - Fax:612-467-5971
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4610103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical