Provider Demographics
NPI:1922176122
Name:MALONE, SUSAN M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:MALONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-5391
Mailing Address - Country:US
Mailing Address - Phone:719-531-5782
Mailing Address - Fax:719-531-5782
Practice Address - Street 1:8750 WESTMINSTER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5391
Practice Address - Country:US
Practice Address - Phone:719-531-5782
Practice Address - Fax:719-531-5782
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0243783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist