Individual
MALLORY JANE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2575 AIRLINE DR, BOSSIER CITY, LA 71111-5812
(318) 746-7466
Mailing address
2415 BENTON RD, BOSSIER CITY, LA 71111-2303
(318) 393-2681
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7108
LA
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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