Basic Information
| Provider Information | |||||||||
| NPI: | 1689218109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLONEE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DENNIS | ||||||||
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| Credential: | L.I.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 WAINWRIGHT DR | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993623975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2119 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989022414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092252524 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2019 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW00009628 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.