Healthcare Provider Details

I. General information

NPI: 1639080500
Provider Name (Legal Business Name): MALLORY RUTH VON GARREL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 CLARKSVILLE PIKE
ELLICOTT CITY MD
21042-6106
US

IV. Provider business mailing address

10087 WOODCHUCK LN
FREDERICK MD
21702-1847
US

V. Phone/Fax

Practice location:
  • Phone: 240-344-8913
  • Fax:
Mailing address:
  • Phone: 240-344-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03392L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: