Basic Information
| Provider Information | |||||||||
| NPI: | 1295318749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | MOLLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3070 DEFIANCE PIKE | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434669763 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 885 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193305119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2021 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.