Provider Demographics
NPI:1609513423
Name:MALLORY, ELEANOR LANOUE
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:LANOUE
Last Name:MALLORY
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 1:11201 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1201
Mailing Address - Country:US
Mailing Address - Phone:410-527-9505
Mailing Address - Fax:
Practice Address - Street 1:11201 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1201
Practice Address - Country:US
Practice Address - Phone:410-527-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist