MEDICARE: KARA MALOSH LMSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1215668694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARA MALOSH LMSW PLLC

Provider Business Mailing Address
First Line	:	456 PLYMOUTH AVE NE STE A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 PLYMOUTH AVE NE STE A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6053
Country	:	US
Telephone Number	:	616-581-9987
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARA N MALOSH
Credential	:	LMSW
Telephone Number	:	616-581-9987

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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