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General NPI Number Information
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NPI Number | 1184586844
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Entity Type | Individual
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Provider Name | MALLORY SUZANNE PAVLIK LPC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 800 S MCHENRY AVE STE F
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7487
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Country | US
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Telephone | 815-526-3750
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Fax | 815-526-3440
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Provider Business Mailing Address
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Address Line | 26W060 BLACKHAWK DR
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City | WHEATON
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State | IL
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Zip | 60189-5904
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Country | US
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Telephone | 630-818-7223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.022211
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License Number State | IL
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