Individual
JENNIFER L MALOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSCW
Contact information
Practice address
2020 E WASHINGTON BLVD, SUITE 700, FORT WAYNE, IN 46803-1359
(260) 422-3034
Mailing address
2020 E WASHINGTON BLVD, SUITE 700, FORT WAYNE, IN 46803-1359
(260) 422-3034
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33005516A
IN
1041C0700X
Clinical Social Worker
Primary
34006055A
IN
Other
Enumeration date
02/12/2009
Last updated
09/30/2010
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