Individual
MALLORY KOCMOUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
3635 E INVERNESS AVE STE 104, MESA, AZ 85206-3848
(480) 719-6535
Mailing address
4760 E BASELINE RD APT 1089, MESA, AZ 85206-4685
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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