Provider Demographics
NPI:1316586506
Name:MALONE, KALLEY WARD
Entity Type:Individual
Prefix:
First Name:KALLEY
Middle Name:WARD
Last Name:MALONE
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 1:2401 W NORCREST DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4346
Mailing Address - Country:US
Mailing Address - Phone:208-371-9474
Mailing Address - Fax:
Practice Address - Street 1:2401 W NORCREST DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4346
Practice Address - Country:US
Practice Address - Phone:208-371-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist