Provider Demographics
NPI:1376996553
Name:BELANGER, MALLORY (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:BELANGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-7275
Mailing Address - Country:US
Mailing Address - Phone:360-457-8575
Mailing Address - Fax:360-457-0795
Practice Address - Street 1:905 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-7275
Practice Address - Country:US
Practice Address - Phone:360-457-8575
Practice Address - Fax:360-457-0795
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61540437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist