Provider Demographics
NPI:1639529761
Name:CLEMENSON, MOLLY ANNE (MT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:CLEMENSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95404 E REATA RD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-9004
Mailing Address - Country:US
Mailing Address - Phone:509-595-0907
Mailing Address - Fax:
Practice Address - Street 1:10121 W CLEARWATER AVE
Practice Address - Street 2:#112
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3500
Practice Address - Country:US
Practice Address - Phone:509-783-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60667578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor