Provider Demographics
NPI:1245850833
Name:BROWN, MALLORY PAIGE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:PAIGE
Last Name:BROWN
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 1:2730 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-9305
Mailing Address - Country:US
Mailing Address - Phone:740-250-9450
Mailing Address - Fax:
Practice Address - Street 1:16349 BEAVER PIKE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-8511
Practice Address - Country:US
Practice Address - Phone:740-286-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist