Provider Demographics
NPI:1043610264
Name:MALIZIA, KAREN LEIGH
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:MALIZIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LEIGH
Other - Last Name:KESTERHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18422 DEMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7819
Mailing Address - Country:US
Mailing Address - Phone:814-512-2326
Mailing Address - Fax:
Practice Address - Street 1:2301 CROWNPOINT EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7824
Practice Address - Country:US
Practice Address - Phone:704-708-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11400235Z00000X
NC11544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist