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General NPI Number Information
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NPI Number | 1235521907
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Entity Type | Individual
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Provider Name | CURTIS J MALLOW SAC
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Gender | Male
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 741 N 1ST ST
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City | WAUSAU
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State | WI
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Zip | 54403-4721
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Country | US
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Telephone | 715-675-3458
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Fax | 715-675-7238
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Provider Business Mailing Address
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Address Line | P.O. BOX 118 PEACEFUL SOLUTIONS COUNSELING
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City | WAUSAU
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State | WI
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Zip | 54402-0118
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Country | US
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Telephone | 715-675-3458
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Fax | 715-675-7238
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15760-131
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License Number State | WI
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