Provider Demographics
NPI:1295280881
Name:LOWRANCE, MALLORY KAY (AUD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:KAY
Last Name:LOWRANCE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:K
Other - Last Name:STUDEBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:9002 N MERIDIAN ST STE 222
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5350
Mailing Address - Country:US
Mailing Address - Phone:317-573-4370
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:1 MEMORIAL SQ
Practice Address - Street 2:SUITE 230
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2835
Practice Address - Country:US
Practice Address - Phone:317-844-7059
Practice Address - Fax:819-819-0044
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002606A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist