Provider Demographics
NPI:1417402538
Name:STINGER, MALLORY
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:STINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 ASPENWAY DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-6601
Mailing Address - Country:US
Mailing Address - Phone:406-249-6412
Mailing Address - Fax:855-249-2776
Practice Address - Street 1:3003 ALDERBROOK CT S
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1626
Practice Address - Country:US
Practice Address - Phone:406-249-6412
Practice Address - Fax:435-200-9442
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
1-16-22846103K00000X
WABA60808207103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10122847-2506Medicaid