Provider Demographics
NPI:1609613751
Name:MALKOWYCH, ALISON (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MALKOWYCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 CHERRYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2504
Mailing Address - Country:US
Mailing Address - Phone:248-444-4946
Mailing Address - Fax:
Practice Address - Street 1:10435 ORTONVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1979
Practice Address - Country:US
Practice Address - Phone:248-605-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist