Healthcare Provider Details

I. General information

NPI: 1013338599
Provider Name (Legal Business Name): KATRINA MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PLEASANT AVE
HAMILTON OH
45015-1133
US

IV. Provider business mailing address

2100 PLEASANT AVE
HAMILTON OH
45015-1133
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-1562
  • Fax: 513-868-1415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1100066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: