Healthcare Provider Details

I. General information

NPI: 1255486890
Provider Name (Legal Business Name): MARCIA DAWSON MALLAMAD MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4553 HINCKLEY INDUSTRIAL PKWY
CLEVELAND OH
44109-6009
US

IV. Provider business mailing address

2963 CORYDON RD
CLEVELAND HEIGHTS OH
44118-3530
US

V. Phone/Fax

Practice location:
  • Phone: 216-635-3504
  • Fax: 216-635-3530
Mailing address:
  • Phone: 216-321-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSP-6223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: