Healthcare Provider Details

I. General information

NPI: 1487613709
Provider Name (Legal Business Name): ANGELA RENAE MOLLENHOFF MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA RENAE JOHNSON MS

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 9TH ST SW
WAVERLY IA
50677-2929
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD SUITE 300-N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-4120
  • Fax: 319-235-5360
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number424
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number741
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: