Provider Demographics
NPI:1326328766
Name:MALLARD, AARON DAEL (BSE)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:DAEL
Last Name:MALLARD
Suffix:
Gender:M
Credentials:BSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:OK
Mailing Address - Zip Code:74369-9549
Mailing Address - Country:US
Mailing Address - Phone:918-325-1851
Mailing Address - Fax:
Practice Address - Street 1:541 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:OK
Practice Address - Zip Code:74369-9549
Practice Address - Country:US
Practice Address - Phone:918-325-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator