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General NPI Number Information
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NPI Number | 1053293357
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Entity Type | Individual
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Provider Name | MOLLIE A RUNDSTROM
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Gender | Female
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 4160 6TH AVE SE
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City | LACEY
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State | WA
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Zip | 98503-1039
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Country | US
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Telephone | 360-259-7179
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Fax |
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Provider Business Mailing Address
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Address Line | 302 FIR ST NE
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City | OLYMPIA
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State | WA
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Zip | 98506-4638
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Country | US
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Telephone | 316-558-0484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC70002859
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License Number State | WA
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