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General NPI Number Information
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NPI Number | 1376471797
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Entity Type | Individual
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Provider Name | BROOKE MORGAN MALLOY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 1110 W PARK PL STE 303
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2784
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Country | US
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Telephone | 208-261-2255
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Fax | 208-473-7271
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Provider Business Mailing Address
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Address Line | 2684 W LUMBER LN
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City | COEUR D ALENE
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State | ID
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Zip | 83814-7419
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Country | US
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Telephone | 607-761-3443
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8971299
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC61321313
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License Number State | WA
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