Provider Demographics
NPI:1700903200
Name:MALONE, MICHAEL J (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MALONE
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5236
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-5236
Mailing Address - Country:US
Mailing Address - Phone:910-638-3353
Mailing Address - Fax:
Practice Address - Street 1:1400 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8042
Practice Address - Country:US
Practice Address - Phone:336-373-9600
Practice Address - Fax:336-373-9676
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6511231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist