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General NPI Number Information
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NPI Number | 1578092060
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Entity Type | Individual
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Provider Name | MALLORY SHARP MA-CF, SLP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 789 STONEYBROOK TRL
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City | FAIRBORN
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State | OH
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Zip | 45324-6021
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Country | US
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Telephone | 937-878-0262
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Fax | 937-878-8407
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Provider Business Mailing Address
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Address Line | 165 LANTERN LN
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City | PLAIN CITY
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State | OH
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Zip | 43064-2104
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Country | US
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Telephone | 614-570-0185
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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 | 2017220
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License Number State | OH
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