Provider Demographics
NPI:1417457011
Name:KATHERINE A MALMROSE MS CCC-SLP
Entity Type:Organization
Organization Name:KATHERINE A MALMROSE MS CCC-SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALMROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:973-616-7338
Mailing Address - Street 1:160 OVERLOOK AVE APT 17E1
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2232
Mailing Address - Country:US
Mailing Address - Phone:201-230-5607
Mailing Address - Fax:
Practice Address - Street 1:160 OVERLOOK AVE STE 1A
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2285
Practice Address - Country:US
Practice Address - Phone:201-230-5607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00452800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty