Individual
JAIME BAUER MALANDRAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
3419 CHESWICK CT APT 2, WEST LAFAYETTE, IN 47906-7451
(646) 532-8221
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
021893-1
NY
235Z00000X
Speech-Language Pathologist
Primary
22005963A
IN
235Z00000X
Speech-Language Pathologist
41YS00695400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000960896
ANTHEM PROVIDER NUMBER
IN
05
—
201317820
—
IN
Enumeration date
09/04/2014
Last updated
05/10/2016
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