Provider Demographics
NPI:1770218224
Name:MALONE-DIETER, JENNIFER L (AAC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:MALONE-DIETER
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 RAGLAND RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-9124
Mailing Address - Country:US
Mailing Address - Phone:360-747-4193
Mailing Address - Fax:
Practice Address - Street 1:550 RAGLAND RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-9124
Practice Address - Country:US
Practice Address - Phone:360-747-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist