Provider Demographics
NPI:1548389026
Name:MALONEY, JASON PAUL (MA CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:MALONEY
Suffix:
Gender:M
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 TARTAN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2691
Mailing Address - Country:US
Mailing Address - Phone:828-406-0439
Mailing Address - Fax:
Practice Address - Street 1:214 TARTAN RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2691
Practice Address - Country:US
Practice Address - Phone:828-406-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412680Medicaid