Provider Demographics
NPI:1306151964
Name:MALBY-MEADE, SUSAN RAE (EDS, MA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RAE
Last Name:MALBY-MEADE
Suffix:
Gender:F
Credentials:EDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 KRESGE LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6435
Mailing Address - Country:US
Mailing Address - Phone:775-359-9200
Mailing Address - Fax:
Practice Address - Street 1:350 KRESGE LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6435
Practice Address - Country:US
Practice Address - Phone:775-359-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000054443103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool