Healthcare Provider Details

I. General information

NPI: 1023397320
Provider Name (Legal Business Name): KATHRYN MALEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E HORIZON DR STE G
HENDERSON NV
89015-8001
US

IV. Provider business mailing address

308 BIRMINGHAM ST
HENDERSON NV
89074-4917
US

V. Phone/Fax

Practice location:
  • Phone: 702-605-2766
  • Fax:
Mailing address:
  • Phone: 725-529-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC15033
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: