Provider Demographics
NPI:1326812199
Name:MALCOLM, WENDY JO
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JO
Last Name:MALCOLM
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 1:2202 ALLEN AVE SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3672
Mailing Address - Country:US
Mailing Address - Phone:440-444-5394
Mailing Address - Fax:
Practice Address - Street 1:516 STOW AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2524
Practice Address - Country:US
Practice Address - Phone:234-678-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide