Healthcare Provider Details

I. General information

NPI: 1316277692
Provider Name (Legal Business Name): MALINDA BARCLAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CENTRAL AVE
ASHLAND OR
97520-1787
US

IV. Provider business mailing address

1000 E MAIN ST
MEDFORD OR
97504-7667
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-0977
  • Fax: 541-488-6141
Mailing address:
  • Phone: 541-500-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL14476
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: