Provider Demographics
NPI:1780019919
Name:IMHOFF, MALLORY ANNE
Entity Type:Individual
Prefix:MISS
First Name:MALLORY
Middle Name:ANNE
Last Name:IMHOFF
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 1:2580 E JOYCE BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3924
Mailing Address - Country:US
Mailing Address - Phone:479-521-7337
Mailing Address - Fax:479-521-7338
Practice Address - Street 1:2580 E JOYCE BLVD STE 12
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3924
Practice Address - Country:US
Practice Address - Phone:479-521-7337
Practice Address - Fax:479-521-7338
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist