Engelhardt, Mallory

Engelhardt, Mallory is an sole proprietor health care provider with primary practice located at 371 E 1St St , Fond Du Lac WI 54935-4563. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Engelhardt, Mallory can be contacted via phone (920) 907-3967.

Contact Information

Primary practice address
371 E 1St St Fond Du Lac WI 54935-4563
Phone: (920) 907-3967
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-20-4110
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 12041110 Wisconsin

Profile Details

NPI number 1467088005
LBN Legal business name Engelhardt, Mallory
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 16th, 2020
Last updated Dec 15th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467088005 NPPES
Wisconsin MEDICAID 356-140

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