Provider Demographics
NPI:1831385327
Name:RAHN, MOLLY SUE (DT/H)
Entity type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:SUE
Last Name:RAHN
Suffix:
Gender:F
Credentials:DT/H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 W KNOLL CREST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7219
Mailing Address - Country:US
Mailing Address - Phone:309-453-8551
Mailing Address - Fax:
Practice Address - Street 1:431 W KNOLL CREST DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7219
Practice Address - Country:US
Practice Address - Phone:309-453-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR500-5578-2913222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist