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General NPI Number Information
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NPI Number | 1588384317
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Entity Type | Individual
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Provider Name | MALLORY CHAGNON
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 17951 JEFFERSON PARK RD STE 100
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130-8439
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Country | US
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Telephone | 440-879-8517
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 CRESCENT DR
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City | PAINESVILLE
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State | OH
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Zip | 44077-1807
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2309259
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License Number State | OH
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