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NPI Code Detail

MEDICARE: MALLORY LARGE

MEDICARE: MALLORY LARGE
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
1235Z00000XSpeech-Language Pathologist146.012244IL

General Provider Information

NPI Number : 1518477363
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY LARGE
Provider Business Mailing Address
First Line : 9049 FAIRWAY DR
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-2717
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11053 S MILLARD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-3327
Country : US
Telephone Number : 773-253-9856
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2017
Last Update Date : 10/06/2017

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Directions to “ MALLORY LARGE ” 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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