Active NPI
Mary Kay Malenic, ST
- Speech-Language Pathologist
- Boardman, OH
National Provider Identifier
1669641783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3937
- Practice address
- 7620 Southern Blvd
Suite 3
Boardman, OH 44512-5667 - Phone
- (330) 965-9330
- Fax
- (330) 965-9308
- NPI assigned
- Feb 22, 2008
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3937 | OH | Primary |
Addresses
Primary practice location
7620 Southern Blvd
Suite 3
Boardman, OH 44512-5667
Mailing address
7620 Southern Blvd
Suite 3
Boardman, OH 44512-5667
Phone (330) 965-9330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3937 | Other | OH | LICENSE NUMBER |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3937 | OH | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwoods Rehabilitation LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Southwoods Physical Therapy
- Special Hospital
- Boardman, OH
- NPI 1528477288
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236643200000",
"number": "1669641783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7620 SOUTHERN BLVD",
"address_2": "SUITE 3",
"city": "BOARDMAN",
"state": "OH",
"postal_code": "445125667",
"telephone_number": "330-965-9330",
"fax_number": "330-965-9308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7620 SOUTHERN BLVD",
"address_2": "SUITE 3",
"city": "BOARDMAN",
"state": "OH",
"postal_code": "445125667",
"telephone_number": "330-965-9330",
"fax_number": "330-965-9308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALENIC",
"first_name": "MARY",
"middle_name": "KAY",
"credential": "ST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-22",
"last_updated": "2009-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "3937",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "3937",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boardman, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.