Provider Demographics
NPI:1295390730
Name:NIDAY, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:NIDAY
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 1:1429 NE POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2357
Mailing Address - Country:US
Mailing Address - Phone:641-680-0273
Mailing Address - Fax:
Practice Address - Street 1:2825 S ANKENY BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9417
Practice Address - Country:US
Practice Address - Phone:515-598-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118243103K00000X
NDL98103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst