Healthcare Provider Details

I. General information

NPI: 1922091727
Provider Name (Legal Business Name): SUSAN MALKOFF SR. LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MOTOR INN DR SUITE #320
GIRARD OH
44420-2420
US

IV. Provider business mailing address

1601 MOTOR INN DR SUITE #320
GIRARD OH
44420-2420
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-0707
  • Fax: 330-759-9708
Mailing address:
  • Phone: 330-759-0707
  • Fax: 330-759-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-1003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: