Provider Demographics
NPI:1194720367
Name:MALLAHAN, MICHAEL STEPHEN (AUD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:MALLAHAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15906 MILL CREEK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1797
Mailing Address - Country:US
Mailing Address - Phone:425-225-2626
Mailing Address - Fax:425-225-2634
Practice Address - Street 1:15906 MILL CREEK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1797
Practice Address - Country:US
Practice Address - Phone:425-225-2626
Practice Address - Fax:425-225-2634
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001117231HA2400X, 231HA2500X, 237600000X
WALD0001117231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089592Medicaid
WA117072OtherDEPT. OF LABOR & IND.
WAMA5615OtherREGENCE ID #
WAMA5615OtherREGENCE ID #
WA7089592Medicaid