MEDICARE: DR. GENEVIEVE MALTBY LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1528780939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GENEVIEVE MALTBY LLC

Provider Business Mailing Address
First Line	:	861 N MADISON ST STE 5
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3058
Country	:	US
Telephone Number	:	815-871-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 N MADISON ST STE 5
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3058
Country	:	US
Telephone Number	:	815-871-2410
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GENEVIEVE MALTBY
Credential	:
Telephone Number	:	815-962-5585

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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