Healthcare Provider Details

I. General information

NPI: 1578374906
Provider Name (Legal Business Name): MOLLY MARIE ZOGAS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CLARK ST
DUBUQUE IA
52001-4551
US

IV. Provider business mailing address

455 CLARK ST
DUBUQUE IA
52001-4551
US

V. Phone/Fax

Practice location:
  • Phone: 630-815-4859
  • Fax:
Mailing address:
  • Phone: 630-815-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number113950
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: