Healthcare Provider Details

I. General information

NPI: 1861306003
Provider Name (Legal Business Name): MALLORY ANN ROFF RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 STAGELINE RD
HUDSON WI
54016-1793
US

IV. Provider business mailing address

405 STAGELINE RD
HUDSON WI
54016-1793
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6636
  • Fax: 715-531-6416
Mailing address:
  • Phone: 715-531-6636
  • Fax: 715-531-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3353-28
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: