Provider Demographics
NPI:1013506062
Name:WOLLENWEBER, MOLLY ALICE RYAN (LCSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ALICE RYAN
Last Name:WOLLENWEBER
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4741
Mailing Address - Country:US
Mailing Address - Phone:630-423-2350
Mailing Address - Fax:
Practice Address - Street 1:128 S COUNTY FARM RD STE C
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2400
Practice Address - Country:US
Practice Address - Phone:630-423-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0228901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical