Individual
ROXANNE MALIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPE
Contact information
Practice address
45 EXECUTIVE DR, JACKSON, TN 38305-2337
(731) 664-2083
(731) 664-1988
Mailing address
18 COUNTRYWAY DR, JACKSON, TN 38305-9026
(731) 664-2083
(731) 664-1988
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PE 1538
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4110536
BCBS PROVIDER NUMBER
TN
Enumeration date
08/29/2006
Last updated
07/09/2007
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