Provider Demographics
NPI:1649943366
Name:KOLQUIST-KUCZA, MOLLY KATHRYN (PSYD, LP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHRYN
Last Name:KOLQUIST-KUCZA
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:KATHRYN
Other - Last Name:KOLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:530 E 2ND ST BLDG E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1913
Practice Address - Country:US
Practice Address - Phone:218-786-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical