| NPI | 1427243542 |
|---|---|
| Former Name | JENNIFER LIANE MALLICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM ccmh0180961) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2020-02-06 |