Provider Demographics
NPI:1003003906
Name:MALONEY, MARY KAYE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAYE
Last Name:MALONEY
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 1:511 INDIAN HILLS APACHE TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9106
Mailing Address - Country:US
Mailing Address - Phone:505-478-2424
Mailing Address - Fax:
Practice Address - Street 1:100 SCHOOL STREET
Practice Address - Street 2:DORA CONSOLIDATED SCHOOLS
Practice Address - City:DORA
Practice Address - State:NM
Practice Address - Zip Code:88115-0327
Practice Address - Country:US
Practice Address - Phone:505-477-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist