Provider Demographics
NPI:1962028274
Name:TRIEBOLD, MALIA (MS)
Entity Type:Individual
Prefix:MS
First Name:MALIA
Middle Name:
Last Name:TRIEBOLD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 AUSTIN ST NE
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-2403
Mailing Address - Country:US
Mailing Address - Phone:715-338-0031
Mailing Address - Fax:
Practice Address - Street 1:3931 LOUISIANA AVE S STE E111
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-5000
Practice Address - Country:US
Practice Address - Phone:715-338-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS