Provider Demographics
NPI:1114458437
Name:MALMROSE, KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:MALMROSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2207
Mailing Address - Country:US
Mailing Address - Phone:201-230-5607
Mailing Address - Fax:
Practice Address - Street 1:160 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2207
Practice Address - Country:US
Practice Address - Phone:201-230-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00452800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist