MEDICARE: MS. DANIELLE MALKMUS MS, 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
1	235Z00000X	Speech-Language Pathologist	41YS01024200	NJ

General Provider Information

NPI Number	:	1902384670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE MALKMUS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	585 HERBERT LN
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1046
Country	:	US
Telephone Number	:	732-773-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 BEAVER DAM RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-5171
Country	:	US
Telephone Number	:	732-773-5219
Fax Number	:

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

Provider Enumeration Date	:	08/03/2018
Last Update Date	:	08/28/2024

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