Provider Demographics
NPI:1689242166
Name:WOLF, MOLLIE C
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:C
Last Name:WOLF
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 1:800 HIAWATHA PL S APT G
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2826
Mailing Address - Country:US
Mailing Address - Phone:510-325-2323
Mailing Address - Fax:
Practice Address - Street 1:800 HIAWATHA PL S APT G
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2826
Practice Address - Country:US
Practice Address - Phone:510-325-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61166173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist