Provider Demographics
NPI:1609433150
Name:MALCOLM, ALLISON (LMSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 175TH ST
Mailing Address - Street 2:
Mailing Address - City:WEVER
Mailing Address - State:IA
Mailing Address - Zip Code:52658
Mailing Address - Country:US
Mailing Address - Phone:319-750-0521
Mailing Address - Fax:
Practice Address - Street 1:509 AVE F
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627
Practice Address - Country:US
Practice Address - Phone:319-372-3566
Practice Address - Fax:319-372-8074
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09136101YA0400X
IA1002411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)