Basic Information
| Provider Information | |||||||||
| NPI: | 1003003906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALONEY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KAYE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 INDIAN HILLS APACHE TRAIL | ||||||||
| Address2: | |||||||||
| City: | PORTALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881309106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054782424 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 SCHOOL STREET | ||||||||
| Address2: | DORA CONSOLIDATED SCHOOLS | ||||||||
| City: | DORA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881150327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054772211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1826 | NM | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.