Healthcare Provider Details

I. General information

NPI: 1609219708
Provider Name (Legal Business Name): TONI MALONE LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N 4TH AVE STE 102
ANN ARBOR MI
48104-5503
US

IV. Provider business mailing address

555 TOWNER ST PO BOX 915
YPSILANTI MI
48198-5752
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-3772
  • Fax: 734-222-3731
Mailing address:
  • Phone: 734-544-3000
  • Fax: 734-555-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802086213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: