Provider Demographics
NPI:1235521907
Name:MALLOW, CURTIS J (SAC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:J
Last Name:MALLOW
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 118
Mailing Address - Street 2:PEACEFUL SOLUTIONS COUNSELING
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-0118
Mailing Address - Country:US
Mailing Address - Phone:715-675-3458
Mailing Address - Fax:715-675-7238
Practice Address - Street 1:741 N 1ST ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4721
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:715-675-7238
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15760-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)