MEDICARE: MRS. SHARON MARIE MALLOY-GROCHOWSKI DOULA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1306178744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON MARIE MALLOY-GROCHOWSKI DOULA

Provider Business Mailing Address
First Line	:	19732 S SKIDMORE CT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-8939
Country	:	US
Telephone Number	:	815-534-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	11267 W 159TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4416
Country	:	US
Telephone Number	:	708-846-6993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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