Provider Demographics
NPI:1790426450
Name:PILGREEN, MOLLY
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:PILGREEN
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 1:5911 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-1937
Mailing Address - Country:US
Mailing Address - Phone:309-397-7284
Mailing Address - Fax:
Practice Address - Street 1:5911 MADISON ST
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-1937
Practice Address - Country:US
Practice Address - Phone:309-397-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker