Active NPI
Natasha Suzanne Mallak, ED.S.
- School Psychologist
- Wausau, WI
National Provider Identifier
1174385256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 3001023842
- Practice address
- 630 S 36TH Ave
Wausau, WI 54401-3930 - Phone
- (715) 842-9500
- NPI assigned
- Jan 25, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 3001023842 | WI | Primary |
Addresses
Primary practice location
630 S 36TH Ave
Wausau, WI 54401-3930
Mailing address
630 S 36TH Ave
Wausau, WI 54401-3930
Phone (715) 842-9500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3001023842 | WI | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706140800000",
"number": "1174385256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 S 36TH AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544013930",
"telephone_number": "715-842-9500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S 36TH AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544013930",
"telephone_number": "715-842-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLAK",
"first_name": "NATASHA",
"middle_name": "SUZANNE",
"credential": "ED.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-25",
"last_updated": "2024-01-25",
"certification_date": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "WI",
"license": "3001023842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.