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NPI Code Detail

MEDICARE: MALLORY CHAGNON

MEDICARE: MALLORY CHAGNON
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
1104100000XSocial WorkerS.2309259OH

General Provider Information

NPI Number : 1588384317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY CHAGNON
Provider Business Mailing Address
First Line : 1225 CRESCENT DR
Second Line :
City : PAINESVILLE
State : OH
Zip : 44077-1807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17951 JEFFERSON PARK RD STE 100
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-8439
Country : US
Telephone Number : 440-879-8517
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2022
Last Update Date : 11/19/2024

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Directions to “ MALLORY CHAGNON ” Practice Location

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