MEDICARE: MALLORY SANDERS MCD, 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	5419	SC

General Provider Information

NPI Number	:	1629474895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY SANDERS MCD, CCC-SLP

Provider Business Mailing Address
First Line	:	3096 NANTUCKETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8973
Country	:	US
Telephone Number	:	843-455-6079
Fax Number	:

Provider Business Practice Location Address
First Line	:	3096 NANTUCKETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8973
Country	:	US
Telephone Number	:	843-455-6079
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	05/01/2025

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Directions to “ MALLORY SANDERS MCD, CCC-SLP” Practice Location

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