Provider Demographics
NPI:1619710175
Name:HOWARD, MALLORY BLAIR (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:BLAIR
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E GAINES ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6157
Mailing Address - Country:US
Mailing Address - Phone:478-595-0317
Mailing Address - Fax:888-249-2172
Practice Address - Street 1:113 E GAINES ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6157
Practice Address - Country:US
Practice Address - Phone:478-595-0317
Practice Address - Fax:888-249-2172
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist