Individual
MALLORY MASSEY ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
3205 JENNY LIND RD, FORT SMITH, AR 72901-7101
(479) 709-6092
Mailing address
18565 KOCUREK RD, GUY, TX 77444-9501
(979) 864-6104
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518089556
—
TX
Enumeration date
09/12/2017
Last updated
08/09/2023
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