Provider Demographics
NPI:1164100095
Name:MALECHA-NAGEL, PENNY SUE
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:SUE
Last Name:MALECHA-NAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 JEAN WAY
Mailing Address - Street 2:
Mailing Address - City:ELKO NEW MARKET
Mailing Address - State:MN
Mailing Address - Zip Code:55054-5421
Mailing Address - Country:US
Mailing Address - Phone:612-382-4603
Mailing Address - Fax:
Practice Address - Street 1:570 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2756
Practice Address - Country:US
Practice Address - Phone:507-301-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health