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General NPI Number Information
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NPI Number | 1770722878
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Entity Type | Individual
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Provider Name | JENNIFER L MALOTT MSW, LSCW
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Gender | Female
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 2020 E WASHINGTON BLVD SUITE 700
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City | FORT WAYNE
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State | IN
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Zip | 46803-1359
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Country | US
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Telephone | 260-422-3034
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 E WASHINGTON BLVD SUITE 700
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City | FORT WAYNE
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State | IN
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Zip | 46803-1359
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Country | US
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Telephone | 260-422-3034
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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 | 33005516A
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License Number State | IN
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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 | 34006055A
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License Number State | IN
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