| NPI | 1538751300 |
|---|---|
| Other Name | KELLY MALLOY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801089270) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801089270) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2022-07-29 |