Healthcare Provider Details

I. General information

NPI: 1659534451
Provider Name (Legal Business Name): MOLLY ANN GILL B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S H ST
TILTON IL
61833-7827
US

IV. Provider business mailing address

302 S H ST
TILTON IL
61833-7827
US

V. Phone/Fax

Practice location:
  • Phone: 217-597-9113
  • Fax:
Mailing address:
  • Phone: 217-597-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: