Individual
MALLORY ELLEN IMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
5211 HIGHWAY 110, AURORA, MN 55705-1522
(218) 229-3311
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-4222
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9978
MN
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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