Individual
JACQUELINE ELIZABETH MALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10910 ROUTE 108, ELLICOTT CITY, MD 21042-0000
(410) 313-5014
(410) 313-5017
Mailing address
5940 WATERLOO RD, COLUMBIA, MD 21045-2630
(410) 313-5014
(410) 313-5017
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
02957L
MD
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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