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General NPI Number Information
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NPI Number | 1760108526
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Entity Type | Individual
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Provider Name | MOLLY KATHRYN LEGRAND LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 527 ILLINOIS AVE
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City | ST CHARLES
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State | IL
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Zip | 60174-3335
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Country | US
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Telephone | 630-549-6245
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Fax |
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Provider Business Mailing Address
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Address Line | 39W305 HERRINGTON BLVD UNIT J2
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City | GENEVA
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State | IL
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Zip | 60134-6249
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Country | US
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Telephone | 630-715-9240
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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 | 149.024830
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License Number State | IL
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