Active NPI
Mollie A Rundstrom
- Clinical Social Worker
- Lacey, WA
National Provider Identifier
1053293357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SC70002859
- Practice address
- 4160 6TH Ave SE
Lacey, WA 98503-1039 - Phone
- (360) 259-7179
- NPI assigned
- Jul 25, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SC70002859 | WA | Primary |
Addresses
Primary practice location
4160 6TH Ave SE
Lacey, WA 98503-1039
Mailing address
302 Fir St NE
Olympia, WA 98506-4638
Phone (316) 558-0484
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
| License | State | Type | Specialty |
|---|---|---|---|
| SC70002859 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753401600000",
"number": "1053293357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 FIR ST NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985064638",
"telephone_number": "316-558-0484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 6TH AVE SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985031039",
"telephone_number": "360-259-7179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUNDSTROM",
"first_name": "MOLLIE",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-25",
"last_updated": "2025-07-25",
"certification_date": "2025-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "SC70002859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.