Individual
MALLORI R WOODALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
815 BENNETT AVE, MEDFORD, OR 97504-6715
(541) 423-2667
Mailing address
1810 CORONA AVE, MEDFORD, OR 97504-5218
(541) 218-0677
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OR
Other
Enumeration date
06/25/2025
Last updated
06/25/2025
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