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General NPI Number Information
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NPI Number | 1659127660
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Entity Type | Individual
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Provider Name | MALLORY LYNN MCIVOR
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Gender | Female
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Dates
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Enumeration Date | 04/29/2024
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 800 S MAIN ST
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City | HARRISONBURG
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State | VA
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Zip | 22807-0001
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Country | US
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Telephone | 412-335-3405
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Fax |
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Provider Business Mailing Address
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Address Line | 56 W GAY ST APT 104
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City | HARRISONBURG
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State | VA
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Zip | 22802-3912
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Country | US
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Telephone | 412-335-3405
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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