Provider Demographics
NPI:1710297148
Name:MCCOLLISTER, MALLORY RANEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:RANEE
Last Name:MCCOLLISTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W WHISPERING ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4875
Mailing Address - Country:US
Mailing Address - Phone:605-359-9450
Mailing Address - Fax:
Practice Address - Street 1:1101 TOM SAWYER TRL
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2105
Practice Address - Country:US
Practice Address - Phone:605-743-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist