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NPI Code Detail

MEDICARE: MALLORY GROENEVELT

MEDICARE: MALLORY GROENEVELT
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 Pathologist7101007321MI

General Provider Information

NPI Number : 1992393219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY GROENEVELT
Provider Business Mailing Address
First Line : 16925 ABILITY WAY
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-9325
Country : US
Telephone Number : 616-935-7606
Fax Number :
Provider Business Practice Location Address
First Line : 16925 ABILITY WAY
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-9325
Country : US
Telephone Number : 616-935-7606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2021
Last Update Date : 01/03/2021

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Directions to “ MALLORY GROENEVELT ” 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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