MEDICARE: MOLLY KROCHALK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5717-125	WI

General Provider Information

NPI Number	:	1487239505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY KROCHALK

Provider Business Mailing Address
First Line	:	1519 SPAIGHT ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3724
Country	:	US
Telephone Number	:	608-320-9039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 SPAIGHT ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3724
Country	:	US
Telephone Number	:	608-320-9039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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Directions to “ MOLLY KROCHALK ” Practice Location

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