Healthcare Provider Details

I. General information

NPI: 1356866545
Provider Name (Legal Business Name): EVAN MALCOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9611 PERCHERON DR
PASCO WA
99301-6687
US

IV. Provider business mailing address

9611 PERCHERON DR
PASCO WA
99301-6687
US

V. Phone/Fax

Practice location:
  • Phone: 717-919-2256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: