Healthcare Provider Details

I. General information

NPI: 1417359373
Provider Name (Legal Business Name): MOLLY BRADLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY ANN SCHOEN

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 BROOKSIDE CT
AUGUSTA KS
67010-2433
US

IV. Provider business mailing address

520 E AUGUSTA AVE
AUGUSTA KS
67010-2100
US

V. Phone/Fax

Practice location:
  • Phone: 316-425-0073
  • Fax:
Mailing address:
  • Phone: 316-775-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4985
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: