MEDICARE: MALLORY CROWE MS, CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	9345	LA

General Provider Information

NPI Number	:	1487499315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY CROWE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5001 E SAINT CHARLES AVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-6751
Country	:	US
Telephone Number	:	337-309-3485
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 E SAINT CHARLES AVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-6751
Country	:	US
Telephone Number	:	337-309-3485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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