Provider Demographics
NPI:1417966995
Name:MALOCHA, STEVEN JOSEPH (MACCCA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:MALOCHA
Suffix:
Gender:M
Credentials:MACCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MANSION ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1167
Mailing Address - Country:US
Mailing Address - Phone:269-789-0015
Mailing Address - Fax:269-789-1551
Practice Address - Street 1:215 E MANSION ST STE 2D
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1167
Practice Address - Country:US
Practice Address - Phone:269-789-0015
Practice Address - Fax:269-789-1551
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004644231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12096655OtherASHA
MI640A300210OtherBCBSM PIN