Provider Demographics
NPI:1518575927
Name:HARRISON, MALLORY ELAINE (MS)
Entity type:Individual
Prefix:MISS
First Name:MALLORY
Middle Name:ELAINE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 BROADLEAF DR
Mailing Address - Street 2:
Mailing Address - City:PARSONSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21849-2575
Mailing Address - Country:US
Mailing Address - Phone:443-944-4855
Mailing Address - Fax:
Practice Address - Street 1:7815 BROADLEAF DR
Practice Address - Street 2:
Practice Address - City:PARSONSBURG
Practice Address - State:MD
Practice Address - Zip Code:21849-2575
Practice Address - Country:US
Practice Address - Phone:443-944-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD02076L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist