MEDICARE: KYRSTEN ANNE MALLOY

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	106S00000X	Behavior Technician		IN

General Provider Information

NPI Number	:	1891638110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRSTEN ANNE MALLOY

Provider Business Mailing Address
First Line	:	625 WOODLAWN AVE
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-1852
Country	:	US
Telephone Number	:	731-777-8009
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W FRANCISCAN DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-4802
Country	:	US
Telephone Number	:	888-998-5269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/13/2026

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Directions to “ KYRSTEN ANNE MALLOY ” Practice Location

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