Provider Demographics
NPI:1831245547
Name:MALISH, LEAH MARIE (CCC-A)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:MALISH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:SURPLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-A
Mailing Address - Street 1:3775 CARMEL VIEW RD
Mailing Address - Street 2:#1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3571
Mailing Address - Country:US
Mailing Address - Phone:858-792-7443
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NMCSD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2404231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist