Provider Demographics
NPI:1841068533
Name:MALMBERG, KRISTINA (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MALMBERG
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3515
Mailing Address - Country:US
Mailing Address - Phone:503-891-4897
Mailing Address - Fax:
Practice Address - Street 1:2611 PRINGLE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1533
Practice Address - Country:US
Practice Address - Phone:503-435-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist