Healthcare Provider Details

I. General information

NPI: 1518575927
Provider Name (Legal Business Name): MALLORY ELAINE ROBY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 OLD MONTGOMERY RD
ELLICOTT CITY MD
21043-7940
US

IV. Provider business mailing address

9054 CONSTANT CRSE
COLUMBIA MD
21046-1617
US

V. Phone/Fax

Practice location:
  • Phone: 410-696-7449
  • Fax:
Mailing address:
  • Phone: 443-944-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09852
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: