Healthcare Provider Details

I. General information

NPI: 1699694174
Provider Name (Legal Business Name): MALLORY WALKER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-59 PUBLIC SQ STE 202
WATERTOWN NY
13601-2674
US

IV. Provider business mailing address

25810 CONTESSA LN
WATERTOWN NY
13601-5890
US

V. Phone/Fax

Practice location:
  • Phone: 315-786-3225
  • Fax:
Mailing address:
  • Phone: 315-786-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: