Individual
JARED MATHEW O'MALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OWNER
Contact information
Practice address
3019 18TH ST S, SAINT CLOUD, MN 56301-4734
(320) 429-2307
Mailing address
3019 18TH ST S, SAINT CLOUD, MN 56301-4734
(320) 429-2307
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
1114406
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000
ADULT FAMILY FOSTER CARE
MN
Enumeration date
01/17/2023
Last updated
01/17/2023
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