Provider Demographics
NPI:1851159438
Name:MCLEAN, MOLLIE SKYLAR
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:SKYLAR
Last Name:MCLEAN
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 1:3133 REID AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-7412
Mailing Address - Country:US
Mailing Address - Phone:310-351-9299
Mailing Address - Fax:
Practice Address - Street 1:10220 CULVER BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3450
Practice Address - Country:US
Practice Address - Phone:310-351-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist