Provider Demographics
NPI:1386971752
Name:MAHALICK, JENNIE MARIE
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIE
Last Name:MAHALICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2449
Mailing Address - Country:US
Mailing Address - Phone:323-246-0960
Mailing Address - Fax:323-346-0966
Practice Address - Street 1:6055 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2449
Practice Address - Country:US
Practice Address - Phone:323-246-0960
Practice Address - Fax:323-346-0966
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator