Individual
MRS. MALLORY BREANNE LIBBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
3150 SAINT CHARLES ST, JASPER, IN 47546-1858
(812) 634-6570
(812) 634-7919
Mailing address
2131 W 5TH AVE, JASPER, IN 47546-9720
(812) 827-1062
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22006418A
IN
Other
Enumeration date
11/21/2022
Last updated
11/21/2022
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