Provider Demographics
NPI:1720100654
Name:HUBBARD, MOLLY JANE (LMP)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JANE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15650 NE 24TH ST
Mailing Address - Street 2:SUITE C2
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2460
Mailing Address - Country:US
Mailing Address - Phone:425-653-1420
Mailing Address - Fax:
Practice Address - Street 1:15650 NE 24TH ST
Practice Address - Street 2:SUITE C2
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2460
Practice Address - Country:US
Practice Address - Phone:425-653-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist