Healthcare Provider Details

I. General information

NPI: 1336052893
Provider Name (Legal Business Name): JANE MALOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLARK ST
HOPKINS MI
49328-9538
US

IV. Provider business mailing address

2243 PARIS AVE SE
GRAND RAPIDS MI
49507-3109
US

V. Phone/Fax

Practice location:
  • Phone: 269-793-7261
  • Fax:
Mailing address:
  • Phone: 989-293-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801116369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: