Provider Demographics
NPI:1831907898
Name:DESLANDES, MOLLY (PSYD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DESLANDES
Suffix:
Gender:X
Credentials:PSYD
Other - Prefix:
Other - First Name:MO
Other - Middle Name:
Other - Last Name:DESLANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1440 RENAISSANCE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1471
Mailing Address - Country:US
Mailing Address - Phone:847-759-9110
Mailing Address - Fax:224-985-2119
Practice Address - Street 1:1440 RENAISSANCE DR STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1471
Practice Address - Country:US
Practice Address - Phone:847-759-9110
Practice Address - Fax:224-985-2119
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071011360OtherSTATE OF ILLINOIS