Provider Demographics
NPI:1932784550
Name:GLEESON, MOLLY ELLEN (LM, LICENSED MIDWIFE)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ELLEN
Last Name:GLEESON
Suffix:
Gender:F
Credentials:LM, LICENSED MIDWIFE
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ELLEN-GLEESON
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:530 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4926
Mailing Address - Country:US
Mailing Address - Phone:503-808-0377
Mailing Address - Fax:707-671-7478
Practice Address - Street 1:530 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4926
Practice Address - Country:US
Practice Address - Phone:503-808-0377
Practice Address - Fax:707-671-7478
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife