Provider Demographics
NPI:1568152700
Name:MALLICOAT, BRANDY K (MSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:K
Last Name:MALLICOAT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-2606
Mailing Address - Country:US
Mailing Address - Phone:815-564-8846
Mailing Address - Fax:
Practice Address - Street 1:119 W 1ST ST STE 110
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3056
Practice Address - Country:US
Practice Address - Phone:815-285-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker