Healthcare Provider Details

I. General information

NPI: 1558426924
Provider Name (Legal Business Name): GREGORY DEAN MALO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E JANATA BLVD SUITE 140
LOMBARD IL
60148-5317
US

IV. Provider business mailing address

163 SADDLE BROOK DR
OAK BROOK IL
60523-2652
US

V. Phone/Fax

Practice location:
  • Phone: 630-424-8900
  • Fax: 630-424-9017
Mailing address:
  • Phone: 630-920-9627
  • Fax: 630-424-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number071-2647
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: