Individual provider Active NPI

Molly Alice Ryan Wollenweber, LCSW, CADC

  • Clinical Social Worker
  • Wheaton, IL
National Provider Identifier
1013506062
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.022890 Issued in IL
Practice address
128 S County Farm Rd Ste C
Wheaton, IL 60187-2400
Phone
(630) 423-2350
NPI assigned
Jan 14, 2021
Last updated
Nov 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.022890 IL Primary

Addresses

Primary practice location

128 S County Farm Rd Ste C
Wheaton, IL 60187-2400

Mailing address

1350 Garfield Ave
Aurora, IL 60506-4741
Phone (630) 423-2350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
149.022890ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Panahi Counseling, PC CurrentSince Nov 10, 2024 Accepting new patients

Locations

128 S County Farm Rd
Ste C
Wheaton, IL 60187
Phone (630) 423-2350

615 W Front St
Wheaton, IL 60187
Phone (630) 246-6988

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1013506062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 GARFIELD AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605064741",
            "telephone_number": "630-423-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 S COUNTY FARM RD STE C",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601872400",
            "telephone_number": "630-423-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLENWEBER",
        "first_name": "MOLLY",
        "middle_name": "ALICE RYAN",
        "name_prefix": "Mrs.",
        "credential": "LCSW, CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-14",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.022890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.