Provider Demographics
NPI:1568293918
Name:CRANDALL, MALLORY (LCSW)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:GEHRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 S PATERSON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4534
Mailing Address - Country:US
Mailing Address - Phone:608-576-0771
Mailing Address - Fax:608-807-5675
Practice Address - Street 1:303 S PATERSON ST STE 1A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4534
Practice Address - Country:US
Practice Address - Phone:608-576-0771
Practice Address - Fax:608-807-5675
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical