Provider Demographics
NPI:1184906521
Name:MALLOY, RENEE L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:MALLOY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HOPKINTON RD
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1000
Mailing Address - Country:US
Mailing Address - Phone:508-733-8402
Mailing Address - Fax:
Practice Address - Street 1:117 HOPKINTON RD
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1000
Practice Address - Country:US
Practice Address - Phone:508-733-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist