Provider Demographics
NPI:1891836599
Name:MALLETT, GRACE (MSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MALLETT
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 1:25685 W HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1054
Mailing Address - Country:US
Mailing Address - Phone:313-274-2855
Mailing Address - Fax:
Practice Address - Street 1:25639 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4817
Practice Address - Country:US
Practice Address - Phone:313-277-3293
Practice Address - Fax:313-277-0917
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker