Provider Demographics
NPI:1205317724
Name:SCHONK, MALLORY DANIELLE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:DANIELLE
Last Name:SCHONK
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 1:37 DOVEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9422
Mailing Address - Country:US
Mailing Address - Phone:410-206-0125
Mailing Address - Fax:
Practice Address - Street 1:650 MCHENRY RD STE 1100
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2607
Practice Address - Country:US
Practice Address - Phone:443-843-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist