Healthcare Provider Details

I. General information

NPI: 1861034472
Provider Name (Legal Business Name): MALLORY LOSCHEN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY PLACEK SLP

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CENTRAL AVE STE 105
KEARNEY NE
68847-2949
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-7182
  • Fax: 308-865-2881
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2494
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: