Provider Demographics
NPI:1952908055
Name:MALONE, CAITLYN MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARIE
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 1:12110 SE 312TH ST APT A302
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3324
Mailing Address - Country:US
Mailing Address - Phone:801-602-1024
Mailing Address - Fax:
Practice Address - Street 1:20 E ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5501
Practice Address - Country:US
Practice Address - Phone:253-931-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61106208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist