Provider Demographics
NPI:1033493549
Name:UNGER, MALISSA ANN
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:ANN
Last Name:UNGER
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 1:1914 STATE HIGHWAY BB
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5950
Mailing Address - Country:US
Mailing Address - Phone:417-243-4005
Mailing Address - Fax:417-243-2663
Practice Address - Street 1:1914 STATE HIGHWAY BB
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5950
Practice Address - Country:US
Practice Address - Phone:417-243-4015
Practice Address - Fax:417-334-6293
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010031414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist