Healthcare Provider Details

I. General information

NPI: 1689267015
Provider Name (Legal Business Name): MALLORY ANNE HAKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PEABODY RD
VACAVILLE CA
95687-6639
US

IV. Provider business mailing address

28447 HIDDEN LAKE DR
BONITA SPRINGS FL
34134-1362
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 630-254-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: