Healthcare Provider Details

I. General information

NPI: 1912822040
Provider Name (Legal Business Name): MALLORY TYLER M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10184 E I25 FRONTAGE RD
FIRESTONE CO
80504-5445
US

IV. Provider business mailing address

6108 SUMMIT PEAK CT UNIT 104
FREDERICK CO
80516-9336
US

V. Phone/Fax

Practice location:
  • Phone: 720-464-6077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0001575
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: