Provider Demographics
NPI:1942504147
Name:MALONE, ANGELA JEAN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEAN
Last Name:MALONE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JEAN
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:16016 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7564
Mailing Address - Country:US
Mailing Address - Phone:509-434-8483
Mailing Address - Fax:
Practice Address - Street 1:1952 E 7000 S STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6878
Practice Address - Country:US
Practice Address - Phone:801-942-3311
Practice Address - Fax:801-942-5955
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00003466235Z00000X
OR13409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist