Individual
MALLORY MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6317 HIGHWAY 329, CRESTWOOD, KY 40014-9040
(502) 384-0910
(502) 384-0908
Mailing address
4529 BILES CT, LOUISVILLE, KY 40241-3703
(816) 830-3840
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12-043
KY
Other
Enumeration date
06/12/2013
Last updated
06/12/2013
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