Basic Information
| Provider Information | |||||||||
| NPI: | 1669415774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALONE | ||||||||
| FirstName: | KIRKLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3399 WEDGEWOOD LN | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321627180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522598070 | ||||||||
| FaxNumber: | 3522057619 | ||||||||
| Practice Location | |||||||||
| Address1: | 3399 WEDGEWOOD LN | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321627180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522598070 | ||||||||
| FaxNumber: | 3522057619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS3772 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.