Provider Demographics
NPI:1992040794
Name:MALLEN, BARBARA CHAMBERLIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:CHAMBERLIN
Last Name:MALLEN
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 1:928 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:DANBY
Mailing Address - State:VT
Mailing Address - Zip Code:05739-9509
Mailing Address - Country:US
Mailing Address - Phone:802-293-5880
Mailing Address - Fax:
Practice Address - Street 1:9 HAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4832
Practice Address - Country:US
Practice Address - Phone:802-747-6456
Practice Address - Fax:802-747-1170
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist