Individual
MALLORY ENGELHARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
371 E 1ST ST, FOND DU LAC, WI 54935-4563
(920) 907-3967
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-20-4110
—
103K00000X
Behavior Analyst
Primary
12041110
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
356-140
—
WI
Enumeration date
03/16/2020
Last updated
12/15/2020
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