Provider Demographics
NPI:1801692959
Name:MALAKOWSKY, ADISON LYDIA
Entity type:Individual
Prefix:
First Name:ADISON
Middle Name:LYDIA
Last Name:MALAKOWSKY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MEREDITH RD
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-1433
Mailing Address - Country:US
Mailing Address - Phone:507-402-4693
Mailing Address - Fax:
Practice Address - Street 1:317 MEREDITH RD
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-1433
Practice Address - Country:US
Practice Address - Phone:507-402-4693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer