Provider Demographics
NPI:1174340350
Name:SHEIK, MALLORI ANN (LICSW)
Entity type:Individual
Prefix:DR
First Name:MALLORI
Middle Name:ANN
Last Name:SHEIK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 CITY HALL ST
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2478
Mailing Address - Country:US
Mailing Address - Phone:218-820-1023
Mailing Address - Fax:
Practice Address - Street 1:5445 CITY HALL ST
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2478
Practice Address - Country:US
Practice Address - Phone:218-820-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN227681041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical