Basic Information
| Provider Information | |||||||||
| NPI: | 1013674167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALCHOW | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2012 WOODCREST CIR | ||||||||
| Address2: | |||||||||
| City: | SARTELL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563774587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206305077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 DEHLER DR | ||||||||
| Address2: | |||||||||
| City: | SARTELL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563774407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516289566 | ||||||||
| FaxNumber: | 3202531037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2021 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 27192 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.