Provider Demographics
NPI:1588993471
Name:SIMKINS SLUK, MOLLY (MA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SIMKINS SLUK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:SIMKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3256 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3416
Mailing Address - Country:US
Mailing Address - Phone:206-790-2364
Mailing Address - Fax:888-972-7936
Practice Address - Street 1:12429 CEDAR RD STE 7
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3172
Practice Address - Country:US
Practice Address - Phone:206-790-2364
Practice Address - Fax:888-972-7936
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60402154106H00000X
OHF.1800045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist