Provider Demographics
NPI:1356642052
Name:HARRELL, MALLORY (MS,CF-SLP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MS,CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 ROLAND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9685
Mailing Address - Country:US
Mailing Address - Phone:501-868-4740
Mailing Address - Fax:501-868-6498
Practice Address - Street 1:20900 ROLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9685
Practice Address - Country:US
Practice Address - Phone:501-868-4740
Practice Address - Fax:501-868-6498
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist