Provider Demographics
NPI:1497242838
Name:MAHONEY, MALLORY HALLETT (ND, RAC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:HALLETT
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:ND, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WOODS WAY STE 9
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-7629
Mailing Address - Country:US
Mailing Address - Phone:231-330-7806
Mailing Address - Fax:
Practice Address - Street 1:3250 WOODS WAY STE 9
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-7629
Practice Address - Country:US
Practice Address - Phone:231-330-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1091175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath