Individual
MALLORY MAHALA RECORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
65 RIDGECREST RD, JACKSON, TN 38305
(731) 668-6076
Mailing address
65 RIDGECREST RD, JACKSON, TN 38305-2359
(731) 668-6076
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5894
TN
Other
Enumeration date
08/22/2017
Last updated
06/05/2018
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