Provider Demographics
NPI:1649593419
Name:MALLAK, JANICE S (ICCE-CD-CPD-IAT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:S
Last Name:MALLAK
Suffix:
Gender:F
Credentials:ICCE-CD-CPD-IAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 MANORDALE DR
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-8988
Mailing Address - Country:US
Mailing Address - Phone:724-327-6063
Mailing Address - Fax:724-327-6063
Practice Address - Street 1:2244 MANORDALE DR
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-8988
Practice Address - Country:US
Practice Address - Phone:724-327-6063
Practice Address - Fax:724-327-6063
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula