Provider Demographics
NPI:1730546433
Name:MALONE, MERIBETH ESTER
Entity type:Individual
Prefix:MISS
First Name:MERIBETH
Middle Name:ESTER
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 1:18229 NW REEDER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-1427
Mailing Address - Country:US
Mailing Address - Phone:971-295-6687
Mailing Address - Fax:
Practice Address - Street 1:18229 NW REEDER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97231-1427
Practice Address - Country:US
Practice Address - Phone:971-295-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10167099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist