Individual
MALLORIE ELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1009 HIGHWAY 2 STE D, SANDPOINT, ID 83864-2713
(208) 610-0996
(208) 625-2046
Mailing address
PO BOX 484, KOOTENAI, ID 83840-0484
(208) 610-0996
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW35962
ID
Other
Enumeration date
08/01/2013
Last updated
08/08/2023
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