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General NPI Number Information
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NPI Number | 1972085777
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Entity Type | Individual
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Provider Name | MALLORY KESSLER CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 14751 CAREY RD
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City | CARMEL
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State | IN
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Zip | 46033-9084
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Country | US
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Telephone | 317-575-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 805 SILVERHEELS DR
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City | WESTFIELD
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State | IN
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Zip | 46074-7643
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Country | US
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Telephone | 317-201-8367
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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 | 22005344A
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License Number State | IN
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