Provider Demographics
NPI:1164197513
Name:FOLZ, MALLORY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:FOLZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 E STATE ROAD 66
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:IN
Mailing Address - Zip Code:47615-9414
Mailing Address - Country:US
Mailing Address - Phone:812-598-3449
Mailing Address - Fax:
Practice Address - Street 1:1115 TAMARACK RD STE 400
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6934
Practice Address - Country:US
Practice Address - Phone:270-926-8534
Practice Address - Fax:270-685-2058
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist