Healthcare Provider Details

I. General information

NPI: 1649593419
Provider Name (Legal Business Name): JANICE S. MALLAK ICCE-CD-CPD-IAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 MANORDALE DR
EXPORT PA
15632-8988
US

IV. Provider business mailing address

2244 MANORDALE DR
EXPORT PA
15632-8988
US

V. Phone/Fax

Practice location:
  • Phone: 724-327-6063
  • Fax: 724-327-6063
Mailing address:
  • Phone: 724-327-6063
  • Fax: 724-327-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: