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NPI Code Detail

MEDICARE: MALLORY RENAE BERRY

MEDICARE: MALLORY RENAE BERRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12355S0801XSpeech-Language AssistantDDS#609AR

General Provider Information

NPI Number : 1336493998
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY RENAE BERRY
Provider Business Mailing Address
First Line : 3400 N WOODS LN
Second Line :
City : ROGERS
State : AR
Zip : 72756-6712
Country : US
Telephone Number : 479-636-3190
Fax Number :
Provider Business Practice Location Address
First Line : 3400 N WOODS LN
Second Line :
City : ROGERS
State : AR
Zip : 72756-6712
Country : US
Telephone Number : 479-636-3190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2012
Last Update Date : 11/05/2012

Similar Medicare Providers

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1861777518 — ELIZABETH BROWN O.T.
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1942585682 — NICOLE CLARK SLP
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Directions to “ MALLORY RENAE BERRY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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