Provider Demographics
NPI:1144988908
Name:MALONE, KAMEELAH R
Entity type:Individual
Prefix:
First Name:KAMEELAH
Middle Name:R
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12959 MORENO BEACH DR APT 8305
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4482
Mailing Address - Country:US
Mailing Address - Phone:951-292-8910
Mailing Address - Fax:
Practice Address - Street 1:12959 MORENO BEACH DR APT 8305
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4482
Practice Address - Country:US
Practice Address - Phone:951-292-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44982355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant