Healthcare Provider Details

I. General information

NPI: 1366010340
Provider Name (Legal Business Name): DANE MALLAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MADISON ST
EVERETT WA
98203-4543
US

IV. Provider business mailing address

PO BOX 2569
EVERETT WA
98213-0569
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-4200
  • Fax:
Mailing address:
  • Phone: 425-212-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: