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Individual

MALLORY JEAN WAISANEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CCC-SLP

Contact information

Practice address
1 HURLEY PLZ, FLINT, MI 48503-5902
(810) 429-8923
Mailing address
9437 SHERIDAN RD, GAINES, MI 48436-8933
(810) 429-8923

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101005773
MI

Other

Enumeration date
10/01/2018
Last updated
12/08/2022
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