Individual
MALLORY BARBARA HERRIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
820 W. COLLEGE AVE, APPLETON, WI 54914
(920) 730-1323
Mailing address
820 W COLLEGE AVE, APPLETON, WI 54914-5286
(920) 730-1323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16148-130
WI
Other
Enumeration date
05/12/2011
Last updated
05/12/2011
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