Provider Demographics
NPI:1558426924
Name:MALO, GREGORY DEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DEAN
Last Name:MALO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SADDLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2652
Mailing Address - Country:US
Mailing Address - Phone:630-920-9627
Mailing Address - Fax:630-424-9017
Practice Address - Street 1:246 E JANATA BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5317
Practice Address - Country:US
Practice Address - Phone:630-424-8900
Practice Address - Fax:630-424-9017
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-2647103TF0200X
IL103G00000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233000OtherBLUE CROSS BLUE SHEILD
ILL 78777Medicare UPIN