Provider Demographics
NPI:1598019531
Name:MALONE, SARA JANE (SLPA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JANE
Last Name:MALONE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23361 MADERO
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2715
Mailing Address - Country:US
Mailing Address - Phone:949-599-0218
Mailing Address - Fax:
Practice Address - Street 1:23361 MADERO
Practice Address - Street 2:SUITE 150
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2715
Practice Address - Country:US
Practice Address - Phone:949-599-0218
Practice Address - Fax:949-470-6195
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 20702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant