MEDICARE: KARI MOLLOY

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	106S00000X	Behavior Technician	RBT-21-151705	IL
2	103K00000X	Behavior Analyst	2023010094	MO

General Provider Information

NPI Number	:	1881270072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI MOLLOY

Provider Business Mailing Address
First Line	:	2055 CRAIGSHIRE RD STE 230
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4012
Country	:	US
Telephone Number	:	815-666-6932
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 CRAIGSHIRE RD STE 230
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4012
Country	:	US
Telephone Number	:	815-666-6932
Fax Number	:

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	06/01/2023

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Directions to “ KARI MOLLOY ” Practice Location

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