Provider Demographics
NPI:1578815593
Name:KIPPES, MALLORY L (SLP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:L
Last Name:KIPPES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-548-5621
Mailing Address - Fax:502-437-0624
Practice Address - Street 1:1800 NEVILLE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3820
Practice Address - Country:US
Practice Address - Phone:502-633-1007
Practice Address - Fax:502-437-0624
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
KY141183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist