Provider Demographics
NPI:1518363183
Name:GRIFFITH, MALLORY (CCC SLP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:317 N MELDRUM ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2023
Mailing Address - Country:US
Mailing Address - Phone:970-495-1150
Mailing Address - Fax:970-495-0133
Practice Address - Street 1:317 N MELDRUM ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2023
Practice Address - Country:US
Practice Address - Phone:970-495-1150
Practice Address - Fax:970-495-0133
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0001788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist