Provider Demographics
NPI:1275084667
Name:GONZALEZ VALENTIN, MALLORY (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:GONZALEZ VALENTIN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:MENTINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2725 S MOORLAND RD STE 301
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:920-683-0210
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4371-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist