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General NPI Number Information
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NPI Number | 1659891463
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Entity Type | Individual
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Provider Name | KAITLIN GABRIELLE MALLERY LSW
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Gender | Female
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 134 W SOUTH BOUNDARY ST STE AA
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City | PERRYSBURG
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State | OH
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Zip | 43551-1770
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Country | US
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Telephone | 567-218-1552
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Fax | 567-429-0185
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Provider Business Mailing Address
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Address Line | 3454 OAK ALLEY CT STE 304
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City | TOLEDO
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State | OH
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Zip | 43606-1365
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Country | US
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Telephone | 672-181-5525
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Fax | 567-429-0185
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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 | 1501149
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License Number State | OH
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