Provider Demographics
NPI:1598088940
Name:MALONE, CHRISTINA (MS, CCC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12196-2611
Mailing Address - Country:US
Mailing Address - Phone:518-283-4838
Mailing Address - Fax:518-283-4838
Practice Address - Street 1:12 PARKER RD
Practice Address - Street 2:
Practice Address - City:WEST SAND LAKE
Practice Address - State:NY
Practice Address - Zip Code:12196-2611
Practice Address - Country:US
Practice Address - Phone:518-283-4838
Practice Address - Fax:518-283-4838
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist