Individual
MRS. MALLORIE BRYAN COSTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
507 HUNTINGTON ROAD, EASLEY, SC 29642
(864) 918-2361
Mailing address
507 HUNTINGTON ROAD, EASLEY, SC 29642
(864) 918-2361
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5677
SC
235Z00000X
Speech-Language Pathologist
SLP - 2084
ID
Other
Enumeration date
04/11/2011
Last updated
06/04/2015
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