Basic Information
| Provider Information | |||||||||
| NPI: | 1891836599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLETT | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25685 W HILLS DR | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481251054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132742855 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25639 FORD RD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481274817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132773293 | ||||||||
| FaxNumber: | 3132770917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801087595 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.