Provider Demographics
NPI:1144478405
Name:MALONE, TAMEKA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:MALONE
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 1:1050 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4830
Mailing Address - Country:US
Mailing Address - Phone:219-663-1507
Mailing Address - Fax:219-864-1783
Practice Address - Street 1:9547 LUEBCKE LN
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-6267
Practice Address - Country:US
Practice Address - Phone:702-588-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004639A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist