MEDICARE: MALINDA ISAACS, PHD PLC

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
1	103T00000X	Psychologist	1569	KY

General Provider Information

NPI Number	:	1760760284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALINDA ISAACS, PHD PLC

Provider Business Mailing Address
First Line	:	1031 WELLINGTON WAY STE 215
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1251
Country	:	US
Telephone Number	:	859-428-8008
Fax Number	:	859-286-6444

Provider Business Practice Location Address
First Line	:	1031 WELLINGTON WAY STE 215
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1251
Country	:	US
Telephone Number	:	859-428-8008
Fax Number	:	859-286-6444

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. MALINDA ISAACS
Credential	:	PH.D.
Telephone Number	:	859-428-8008

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	05/09/2016

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