Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6851114131 | MI |
N | 106S00000X | Behavior Technician |
NPI | 1003300542 |
---|---|
Provider Name | Paige L Malay |
First Address | Fenton, MI 48430-3327 |
Second Address | New Hudson, MI 48165-8521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2018 |
Last Update Date | 01/02/2022 |