Provider Demographics
NPI:1720151376
Name:GREGAN, MOLLY COLLEEN
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:COLLEEN
Last Name:GREGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:COLLEEN
Other - Last Name:GREGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13224 N 94TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4359
Mailing Address - Country:US
Mailing Address - Phone:602-321-0802
Mailing Address - Fax:
Practice Address - Street 1:4848 E CACTUS RD STE 940
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4164
Practice Address - Country:US
Practice Address - Phone:602-321-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4846235500000X
AZ5363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ976186OtherAHCCCS NUMBER