Individual
DR. BRIAN C MALLIETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
1466 HUNTERS RUN DR, BOURBONNAIS, IL 60914-4520
(815) 474-9550
Mailing address
1466 HUNTERS RUN DR, BOURBONNAIS, IL 60914-4520
(815) 474-9550
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1907241
IL
Other
Enumeration date
09/20/2017
Last updated
07/21/2022
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