NPI | 1124519145 |
---|---|
Former Name | MALLORY BUTLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0005885) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA14700) |
Enumeration Date | 2018-05-24 |
Last Update Date | 2024-07-28 |