Provider Demographics
NPI:1447728100
Name:MOLKO, VICTORIA (LPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MOLKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LEDESMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6266 SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1731
Mailing Address - Country:US
Mailing Address - Phone:509-713-6016
Mailing Address - Fax:
Practice Address - Street 1:7400 METRO BLVD STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2321
Practice Address - Country:US
Practice Address - Phone:509-713-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional