Healthcare Provider Details

I. General information

NPI: 1164101234
Provider Name (Legal Business Name): MALLIE PHILIPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15701 E 1ST AVE
AURORA CO
80011-9060
US

IV. Provider business mailing address

15701 E 1ST AVE
AURORA CO
80011-9060
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-8060
  • Fax:
Mailing address:
  • Phone: 303-344-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: