Individual
CHARLES ALBERT MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
1430 OLIVE ST, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Mailing address
8640 NEALY LN, EDWARDSVILLE, IL 62025-7018
(618) 656-3972
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
0011228854
MO
Other
Enumeration date
11/03/2011
Last updated
11/03/2011
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