Provider Demographics
NPI:1124466305
Name:MOLOKKEN, BOBBI-JO (LISW, IADC)
Entity type:Individual
Prefix:
First Name:BOBBI-JO
Middle Name:
Last Name:MOLOKKEN
Suffix:
Gender:F
Credentials:LISW, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 PANORAMIC RD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7318
Mailing Address - Country:US
Mailing Address - Phone:563-223-8677
Mailing Address - Fax:
Practice Address - Street 1:615 GRANT AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2111
Practice Address - Country:US
Practice Address - Phone:563-223-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0070881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical