Healthcare Provider Details

I. General information

NPI: 1457843278
Provider Name (Legal Business Name): MALEAH CHERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 LA MESA BLVD # 416
LA MESA CA
91942-0335
US

IV. Provider business mailing address

PO BOX 5157
MODESTO CA
95352-5157
US

V. Phone/Fax

Practice location:
  • Phone: 619-567-9448
  • Fax:
Mailing address:
  • Phone: 209-572-2589
  • Fax: 209-572-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number37447
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122861
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-56618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: