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Mallory Polivka, MA,R-DMT
Student in an Organized Health Care Education/Training Program in Duluth, Minnesota
NPI 1821514563

Mallory Polivka is a Student in an Organized Health Care Education/Training Program based in Duluth, MN. Mallory Polivka practices in Duluth, MN and has the professional credentials of MA,R-DMT. The NPI Number for Mallory Polivka is 1821514563 and holds a License No. (Minnesota).

The current practice location address for Mallory Polivka is 101 W 2Nd St, Duluth, MN and can be reached out via phone at 218-724-3122.

Location: 101 W 2Nd St, Duluth, MN, 55803-2127
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1821514563
Provider Name
Mallory Polivka
Credential
MA,R-DMT
Provider Entity Type
Individual
Gender
Female
Address
101 W 2Nd St, Duluth, MN, 55803-2127
Phone Number
218-724-3122
Fax Number
Provider Enumeration Date
08/15/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
101 W 2Nd St
City
Duluth
State
Minnesota
Zip
55802
Phone Number
218-724-3122
Fax Number
person
Provider Business Mailing Address Details
Address
101 W 2Nd St
City
Duluth
State
Minnesota
Zip
55802
Phone Number
218-724-3122
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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