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General NPI Number Information
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NPI Number | 1104769579
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Entity Type | Individual
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Provider Name | MALLORY BROCK
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Gender | Female
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | COOKEVILLE
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State | TN
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Zip | 38501-4294
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Country | US
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Telephone | 931-528-2541
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Fax |
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Provider Business Mailing Address
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Address Line | 75 E VETERANS DR APT A302
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City | COOKEVILLE
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State | TN
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Zip | 38501-4698
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Country | US
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Telephone | 251-709-9984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6007
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 0884
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License Number State | TN
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