Provider Demographics
NPI:1720402118
Name:JOY, MALIA (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:JOY
Suffix:
Gender:F
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 1:400 N MCCLURG CT
Mailing Address - Street 2:APT 3006
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4323
Mailing Address - Country:US
Mailing Address - Phone:443-904-4384
Mailing Address - Fax:
Practice Address - Street 1:400 N MCCLURG CT
Practice Address - Street 2:APT 3006
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4323
Practice Address - Country:US
Practice Address - Phone:443-904-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist