Provider Demographics
NPI:1144811308
Name:MOLESKY, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MOLESKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24230 S. JANET STREET
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442
Mailing Address - Country:US
Mailing Address - Phone:773-401-8132
Mailing Address - Fax:
Practice Address - Street 1:295 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416
Practice Address - Country:US
Practice Address - Phone:815-515-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional