Provider Demographics
NPI:1578770731
Name:MALONE, KATHY (LBSW, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LBSW, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6672 E RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8287
Mailing Address - Country:US
Mailing Address - Phone:810-229-3328
Mailing Address - Fax:
Practice Address - Street 1:6672 EAST RIDGE CT.
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-8287
Practice Address - Country:US
Practice Address - Phone:810-229-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169040163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant