Provider Demographics
NPI:1730197138
Name:GRATTON, MOLLY (LSCSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GRATTON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-576-6464
Mailing Address - Fax:208-392-1378
Practice Address - Street 1:2995 N COLE RD
Practice Address - Street 2:SUITE 270
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-576-6464
Practice Address - Fax:208-392-1378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID275061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1730197138Medicaid