Provider Demographics
NPI:1255968079
Name:MALLAMACI, CONSTANCE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:MALLAMACI
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 1:9516 TOWNSHIP ROAD 251
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9580
Mailing Address - Country:US
Mailing Address - Phone:419-957-9587
Mailing Address - Fax:
Practice Address - Street 1:15100 BIRCHAVEN LN
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9773
Practice Address - Country:US
Practice Address - Phone:419-424-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.06789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist