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NPI Code Detail

MEDICARE: MARCIA DAWSON MALLAMAD MA CCC SLP

MEDICARE: MARCIA DAWSON MALLAMAD MA CCC SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistSP-6223OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1340753561028OTHEROHCARESOURCE ID

General Provider Information

NPI Number : 1255486890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCIA DAWSON MALLAMAD MA CCC SLP
Provider Business Mailing Address
First Line : 2963 CORYDON RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-3530
Country : US
Telephone Number : 216-321-7884
Fax Number :
Provider Business Practice Location Address
First Line : 4553 HINCKLEY INDUSTRIAL PKWY
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-6009
Country : US
Telephone Number : 216-635-3504
Fax Number : 216-635-3530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 01/04/2010

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