Individual
MRS. ALICIA RENA MALLADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
7733 FORSYTH BLVD, SAINT LOUIS, MO 63105-1817
(800) 677-1202
Mailing address
458 MELODY LN, CUBA, MO 65453-8197
(573) 885-6269
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
116651
MO
Other
Enumeration date
08/21/2008
Last updated
08/21/2008
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