Provider Demographics
NPI:1699835512
Name:MALCOMSON, DAVID LEE I (MS,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:MALCOMSON
Suffix:I
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2836
Mailing Address - Country:US
Mailing Address - Phone:330-386-3277
Mailing Address - Fax:330-386-3277
Practice Address - Street 1:320 W 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2836
Practice Address - Country:US
Practice Address - Phone:330-386-3277
Practice Address - Fax:330-386-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0172235Z00000X
OHSP-2791235Z00000X
OH1160237700000X
WV435237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629538Medicaid
WV0148563001Medicaid