Provider Demographics
NPI:1841810736
Name:ENGEL, MALLORY (IBCLC, CPM, LLM)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:ENGEL
Suffix:
Gender:F
Credentials:IBCLC, CPM, LLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-8557
Mailing Address - Country:US
Mailing Address - Phone:916-792-6716
Mailing Address - Fax:
Practice Address - Street 1:2104 EDWARDS RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-8557
Practice Address - Country:US
Practice Address - Phone:916-792-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-142573174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN